The validity of brief screening cognitive instruments in the diagnosis of cognitive impairment and dementia after first-ever stroke

Introduction: Brief cognitive tests such as the Mini-mental State Examination (MMSE) and the Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE) have been used to detect cognitive impairment and dementia in studies of stroke patients. However, there are few data on their validity f...

Full description

Saved in:
Bibliographic Details
Published in:International psychogeriatrics 2006-06, Vol.18 (2), p.295-305
Main Authors: Srikanth, Velandai, Thrift, Amanda G., Fryer, Jayne L., Saling, Michael M., Dewey, Helen M., Sturm, Jonathan W., Donnan, Geoffrey A.
Format: Article
Language:English
Subjects:
Aged
Alzheimer Disease - classification
Alzheimer Disease - diagnosis
Alzheimer Disease - etiology
Australia - epidemiology
Biological and medical sciences
Cognition Disorders - classification
Cognition Disorders - diagnosis
Cognition Disorders - etiology
Cognitive ability
Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases
Dementia
Dementia - classification
Dementia - diagnosis
Dementia - etiology
Diagnosis, Differential
Geriatrics
Humans
Incidence
Mass Screening - methods
Medical diagnosis
Medical sciences
Medical screening
Mini-Mental State Examination
Neurology
Neuropsychological assessment
Psychological Tests
Psychology. Psychoanalysis. Psychiatry
Psychopathology. Psychiatry
Regression Analysis
Reproducibility of Results
Stroke
Stroke - complications
Stroke - epidemiology
Validity
Vascular diseases and vascular malformations of the nervous system
Citations: Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Introduction: Brief cognitive tests such as the Mini-mental State Examination (MMSE) and the Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE) have been used to detect cognitive impairment and dementia in studies of stroke patients. However, there are few data on their validity for such use. We have evaluated their validity in detecting cognitive impairment not dementia (CIND) and dementia in a community-based sample of first-ever stroke patients. Methods: The standardized MMSE (S-MMSE) and the 16-item IQCODE were administered to 79 patients 1 year after a first-ever stroke. CIND and dementia were diagnosed independently using a comprehensive cognitive battery. The performances of the two tests were evaluated using receiver operating characteristic (ROC) analyses. Combined performance was evaluated when their scores were used in parallel (the “or rule”), in series (the “and rule”) or as a weighted sum (the “weighted sum rule”). Results: Both tests were extremely poor at detecting CIND individually and in combination. For dementia, at traditional cut-points, the S-MMSE (≤23) was insensitive (0.50, 95% CI 0.16–0.84) and the IQCODE (≥3.30) nonspecific (0.63, 95% CI 0.51–0.75). An acceptable balance between sensitivity and specificity was achieved for dementia using the “or rule” combination, but with only modest positive predictive value. Conclusions: The S-MMSE and the IQCODE were individually poor at detecting CIND and dementia after a nonaphasic first-ever stroke. The combination was useful in detecting dementia but it does not replace the need for detailed neuropsychological tests.
ISSN:1041-6102
1741-203X
DOI:10.1017/S1041610205002711