A recently published meta-analysis of the effectiveness of different cognitive screens in detecting dementia stated that the Mini-Cog and the ACE-R are the best alternative screening tests to the MMSE due to their high pooled sensitivity and specificity compared to other alternative screens. While two sets of reviews recommended the very brief Mini-Cog, GPCOG and MIS for use in general practice, another review recommended more comprehensive screens (3MS, CASI, SASSI, and ACE-R). 2003 5600:1129-1135.ĭear Drs Tsoi, Chan, Hirai, Wong, and Kwok, Several recent reviews of the relative utility of cognitive screening instruments have come to different conclusions. The diagnostic odds ratio: a single indicator of test performance. Glas AS, Lijmer JG, Prins MH, Bonsel GJ, Bossuyt PM.
Cognitive Tests to Detect Dementia: A Systematic Review and Meta-analysis. Tsoi KKF, Chan JYC, Hirai HW, Wong SYS, Kwok TCY. A review of screening tests for cognitive impairment. 3.Ĝullen B, O'Neill B, Evans JJ, Coen RF, Lawlor BA. Screening for dementia in primary care: a review of the use, efficacy and quality of measures. Milne A, Culverwell A, Guss R, Tuppen J, Whelton R. Unless the authors can demonstrate how their conclusions are supported by their data, we believe that the conclusion should have been revised to reflect that the Mini-Cog and GPCOG have at least equivalent diagnostic efficiency for detecting dementia. Since a higher level of dementia prevalence positively biases the chances of detecting dementia, accounting for prevalence may have further increased the sensitivity and specificity of the GPCOG relative to the Mini-Cog. Furthermore, the reported prevalence of dementia in the Mini-Cog studies (1182/4178 28.3%) was slightly higher than that of the GPCOG (292/1082 27.0%). Taking reported pooled sensitivity (Se) and specificity (Sp) alone, where DOR = (Se x Sp)/((1 – Se) x (1 – Sp)) the GPCOG (76.96) performs better than the Mini-Cog (62.11). While we agree with this approach, this measure was not reported in the Abstract, Results or online Supplementary Material, so it is unclear to the reader how or if the DOR was actually used to support their conclusions independently of pooled sensitivity and specificity. In contrast to these reported measures, in the Methods the authors state that a diagnostic odds ratio (DOR) was used as a single indicator of test performance, to account for the trade-off between sensitivity and specificity in the context of different thresholds used across studies. In addition, while the confidence intervals are equally wide between the tests for sensitivity, for specificity they are narrower for the GPCOG than the Mini-Cog.
However, the reported values for the GPCOG are numerically higher with respective values of 0.92 (0.81-0.97) and 0.87 (0.83-0.90). The Mini-Cog is reported to have pooled sensitivity and specificity values of 0.91 (0.80-0.96) and 0.86 (0.74-0.93), respectively. However the data are at odds with this conclusion.
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