Abstract
INTRODUCTION:To be useful, Brief Cognitive Tests (BCTs) must be fast, sensitive, easy to perform, and not require extensive training to do so. Commonly used brief cognitive tests include the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA).
OBJECTIVE:To provide a description of the available BCTs and their psychometric properties for the detection of dementia.
METHODS:Narrative review
RESULTS:The MMSE places great weight on orientation, memory, visuospatiality, and language, and, consequently, may be sensitive to the cognitive deficits found in Alzheimer's dementia. MoCA is a more complex brief test that assesses a broader range of cognitive domains, especially executive functions, providing greater sensitivity for detecting mild cognitive impairment and other types of dementia, not just Alzheimer's dementia.
CONCLUSIONS:BCTs are part of the arsenal needed to help confirm suspected dementia. Schooling has an important impact on the performance of BCTs and can bias the interpretation of the results obtained.
References
Pottie K, Rahal R, Jaramillo A, Birtwhistle R, Thombs B.D, Singh H, Gorber, et al. Recommendations on screening for cognitive impairment in older adults. CMAJ. 2016;188(1):37-46. https://doi.org/10.1503/cmai.141165
Cullen B, O'Neill B, Evans JJ, Coen R, Lawlor B. A review of screening tests for cognitive impairment. J Neurol Neuro-surg Psychiatry. 2007;78(8):790-9. https://doi.org/10.1136/jnnp.2006.095414
De Koning I, Van Kooten F, Koudstaal PJ. Value of screening instruments in the diagnosis of post-stroke dementia. Haemostasis. 1998;28(3-4):158-66. https://doi.org/10.1159/000022427
De Roeck EE, De Deyn PP, Dierckx E, Engelborghs S. Brief cognitive screening instruments for early detection of Alzheimer's disease: a systematic review Alzheimers Res Ther. 2019;11(1):21. https://doi.org/10.1186/s13195-019-0474-3
Custodio N, Duque L, Montesinos R, Alva-Díaz C, Mellado M, Slachevsky A. Systematic review of the diagnostic validity of brief cognitive screenings for early dementia detection in Spanish-speaking adults in Latin America. Front Aging Neurosci. 2020:12(270):1-13. https://doi.org/10.3389/fnagi.2020.00270
Brown J. The use and misuse of short cognitive tests in the diagnosis of dementia. J Neurol Neurosurg Psychiatry. 2015;86(6):680-5. https://doi.org/10.1136/jnnp-2014-309086
Prieto G, Contador I, Tapias-Merino E, Mitchell AJ, Bermejo-Pareja F. The Mini-Mental-37 test for dementia screening in the Spanish population: An analysis using the Rasch Model. Clin Neuropsychol. 2012;26:1003-18. https://doi.org/10.1080/13854046.2012.704945
Custodio N, Becerra-Becerra Y, Cruzado L, Castro-Suárez S, Montesinos R, Bardales Y, et al. Nivel de conocimientos sobre demencia frontotemporal en una muestra de médicos que evalúan regularmente a pacientes con demencia en Lima-Perú. Rev Chil Neuro-Psiquiatr. 2018;56:77-88. https://doi.org/10.4067/s0717-92272018000200077
Parra M, Baez S, Allegri R, Nitrini R, Lopera F, Slachevsky A, et al. Dementia in Latin America: Assessing the present and envisioning the future. Neurology. 2018;90:222-31. https://doi.org/10.1212/WNL.0000000000004897
Prince M, Acosta D, Ferri C, Guerra M, Huang Y, Jacob K, et al. A brief dementia screener suitable for use by non-specialists in resource poor settings-the cross-cultural derivation and validation of the brief Community Screening Instrument for Dementia. Int. J. Geriatric Psychiatry. 2011;26:899-907. https://doi.org/10.1002/gps.2622
Ramos-Cerqueira AT, Torres AR, Crepaldi AL, Oliveira NI, Scazufca M, Meneses P R, et al. Identification of dementia cases in the community: a Brazilian experience. J Am Geriatr Soc. 2005;53:1738-42. https://doi.org/10.1111/j.1532-5415.2005.53553.x
Monroe T, Carter M. Using the Folstein Mini Mental State Exam (MMSE) to explore methodological issues in cognitive aging research. Eur J Ageing. 2012;9(3):265-74. https://doi.org/10.1007/s10433-012-0234-8
Tombaugh TN, McIntyre NJ. The mini-mental state examination: a comprehensive review. J Am Geriatr Soc. 1992;40(9):922-35. https://doi.org/10.1111/j.1532-5415.1992.tb01992.x.
Espino D, Lichtenstein M, Palmer R, Hazuda H. Ethnic differences in Mini-Mental State Examination (MMSE) scores: Where you live makes a difference. J Am Geriatric Soc. 2001;49(5):538-48. https://doi.org/10.1046/j.1532-5415.2001.49111.x
Spering C, Hobson V, Lucas J, Menon C, Hall J, O'Bryant S. Diagnostic accuracy of the MMSE in detecting probable and possible Alzheimer's disease in ethnically diverse highly educated individuals: an analysis of the NACC database. J Gerontol A Biol Sci Medi Sci. 2012;67(8):890-6. https://doi.org/10.1093/gerona/gls006
Kochhann R, Cerveira M, Godinho C, Camozzato A, Chaves M. Evaluation of Mini-Mental State Examination scores according to different age and education strata, and sex, in a large Brazilian healthy sample. Dement Neuropsychol. 2009;3(2):88-93. https://doi.org/10.1590/S1980-57642009DN30200004
O'Bryant S, Humphreys J, Smith G, Ivnik R, Graff-Radford N, Petersen R, et al. Detecting dementia with the minimental state examination in highly educated individuals. Arch Neurol. 2008;65(7):963-7. https://doi.org/10.1001/archneur.65.7.963
Ostrosky-Solís F, López-Arango G, Ardila A. Sensitivity and specificity of the Mini-Mental State Examination in a Spanish-speaking population. Appl Neuropsychol- 2000;7:25-31. http://dx.doi.org/10.1207/S15324826AN0701_4
Pradilla G, Vesga B, León-Sarmiento FE, Rosselli D, Bautista L, Morillo M, et al. Estudio neuroepidemiológico nacional (Epineuro) colombiano. Rev Panam Salud Pública. 2003;14(2):104-11. http://doi.org/10.1590/s1020-49892003000700005
Rosselli D, Ardila A, Pradilla G, Morillo L, Bautista L, Rey O, et al. El examen mental abreviado (Mini-Mental State Examination) como prueba de selección para el diagnóstico de demencia: un estudio poblacional colombiano. Neurología. 2000;30:428-32.
Nasreddine S, Phillips N, Bédirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695-9. https://doi.org/10.1111/j.1532-5415.2005.53221.x
Velayudhan L, Ryu S, Raczek M, Philpot M, Lindesay J, Critchfield M, et al. Review of brief cognitive tests for patients with suspected dementia. Int. Psychogeriatr. 2014;26:1247-62. https://doi.org/10.1017/S1041610214000416
Loureiro C, García C, Adana L, Yacelga T, Rodríguez-Lorenzana A, Maruta C. Uso del test de evaluación cognitiva de Montreal (MoCA) en América Latina: revisión sistemática. Rev Neurol 2018; 66: 397-408.
Julayanont P, Nasreddine Z. S. Montreal Cognitive Assessment (MoCA): concept and clinical review. In: Larner A, editors. Cognitive screening instruments. London: Springer; 2013. p.139-95.
Ciesielska N, Sokolowski R, Mazur E, Podhorecka M, Polak-Szabela A, Kedziora-Kornatowska K. Is the Montreal Cognitive Assessment (MoCA) test better suited than the Mini-Mental State Examination (MMSE) in mild cognitive impairment (MCI) detection among people aged over 60? Meta-analysis. Psychiatr Pol. 2016;50(5):1039-52. https://doi.org/10.12740/PP/45368
Dong Y, Lee W, Basri N, Collinson S, Merchant R, Venketasubramanian N, et al. The Montreal Cognitive Assessment is superior to the Mini-Mental State Examination in detecting patients at higher risk of dementia. Int Psycho-geriatric. 2012;24(11):1749-55. https://doi.org/10.1017/S1041610212001068
Ojeda N, Pino R, Ibarretxe-Bilbao N, Schretlen D, Peña J. Test de evaluación cognitiva de Montreal: normalización y estandarización de la prueba en población española. Rev Neurol. 2016;63(11):488-96. https://doi.org/10.33588/rn.6311.2016241
Delgado C, Araneda A, Behrens M. Validación del instrumento Montreal Cognitive Assessment en español en adultos mayores de 60 años. Neurol. 2019;34(6):376-85. https://doi.org/10.1016/j.nrl.2017.01.013
Gómez F, Zunzunegui MV, Lord C, Alvarado B, García, A. Applicability of the MoCA-S test in populations with little education in Colombia. Int J Geriatr Psychiatry. 2013;28:813-20. https://doi.org/10.1002/gps.3885
Woodford HJ, George J. Cognitive assessment in the elderly: a review of clinical methods. QJM. 2007;100(8):469-84. https://doi.org/10.1093/qjmed/hcm051
Manos PJ, Wu R. The ten point clock test: a quick screen and grading method for cognitive impairment in medical and surgical patients. Int J Psychiatry Med. 1994;24(3):229-44. https://doi.org/10.2190/5A0F-936P-VG8N-0F5R
Ehreke L, Luppa M, Kónig HH, Riedel-Heller SG. Is the Clock Drawing Test a screening tool for the diagnosis of mild cognitive impairment? A systematic review Int Psychogeriatr. 2010;22(1):56-63. https://doi.org/10.1017/S1041610209990676
Cahn-Weiner DA, Williams K, Grace J, Tremont G, Westervelt H, Stern RA. Discrimination of dementia with Lewy bodies from Alzheimer disease and Parkinson disease using the clock drawing test. Cogn Behav Neurol. 2003;16(2):85-92. https://doi.org/10.1097/00146965-200306000-00001
Shulman KI. Clock-drawing: is it the ideal cognitive screening test? Int J Geriatr Psychiatry. 2000;15(6):548-61. https://doi.org/10.1002/1099-1166(200006)15:6<548::aid-gps242>3.0.co;2-u
Borson S, Scanlan J, Brush M, Vitaliano P, Dokmak A. The Mini-Cog: a cognitive 'vital signs' measure for dementia screening in multi-lingual elderly. Int J Geriatr Psychiatry . 2000;15(11):1021-7. https://doi.org/10.1002/1099-1166(200011)15:11<1021::aid-gps234>3.0.co;2-6
Scanlan J, Borson S. The Mini-Cog: receiver operating characteristics with expert and naive raters. Int J Geriatr Psychiatry . 2001;16(2):216-22. https://doi.org/10.1002/1099-1166(200102)16:2<216::aid-gps316>3.0.co;2-b
Torres-Castroa S, Mena-Montesa B, González-Ambrosioa G, Zubieta-Zavalab A, Torres-Carrilloc N, Acosta-Castillod G, et al. Escalas de tamizaje cognitivo en habla hispana: una revisión crítica. Neurología. 2018:S0213-4853(18)30094-X. https://doi.org/10.1016/j.nrl.2018.03.009
Kaufer D, Williams C, Braaten A, Gill K, Zimmerman S, Sloane P. Cognitive screening for dementia and mild cognitive impairment in assisted living: Comparison of 3 tests. J Am Med Dir Assoc. 2008;9;586-93. http://dx.doi.org/10.1016/j.jamda.2008.05.006
Dubois B, Feldman HH, Jacova C, Cummings JL, Dekosky ST, Barberger-Gateau P, et al. Revising the definition of Alzheimer's disease: a new lexicon. Lancet Neurol. 2010; 9(11):1118-27. https://doi.org/10.1016/S1474-4422(10)70223-4
Rozzini L, Ceraso A, Zanetti M, Pelizzari S, Tomasoni E, Accardo V, et al. The Italian version of the five-word test: A simple diagnostic test for dementia due to Alzheimer's disease in routine clinical practice. Behav Neurol. 2017: 2017:3781407. https://doi.org/10.1155/2017/3781407
Mimenza-Alvarado AJ, Bombón-Albán P, Duarte-Flores O, Gutiérrez-Gutiérrez L, Avila-Funes A, Aguilar-Navarro S. Five-Word Test, screening of mixed dementia in older adults: Validation study. Rev Colomb Psiquiat. 2021;S0034-7450(21)00085-8. https://doi.org/10.1016/j.rcp.2021.04.009
Torralva T, Roca M, Gleichgerrcht E, Lopez P, Manes, F. INECO Frontal Screening (IFS): a brief, sensitive, and specific tool to assess executive functions in dementia. J Int Neuropsychol. 2000;15(5):777-86. https://doi.org/10.1017/S1355617709990415
Ihnen J, Antivilo A, Muñoz-Neira C, Slachevsky A. Chilean version of the INECO Frontal Screening (IFS.Ch): psychometric properties and diagnostic accuracy. Dement Neuropsychol. 2013;7(1):40-7. https://doi.org/10.1590/S1980-57642013DN70100007
Reyes de Beaman S, Beaman PE, Garcia-Pena C, Villa MA, Heres J, Córdova A, Jagger C. Validation of a modified version of the Mini-Mental State Examination (MMSE) in Spanish. Aging Neuropsychol Cogn. 2004;11(1):1-1. http://doi.org/10.1076/anec.11.1.1.29366
Quiroga P, Albala C, Klaasen G. Validation of a screening test for age associated cognitive impairment, in Chile. Rev Méd Chile. 2004;132(4):467-78.
Villasenor-Cabrera T, Guàrdia-Olmos J, Jiménez-Maldonado M, Rizo-Curiel G, Per6-Cebollero M. Sensitivity and specificity of the Mini-Mental State Examination in the Mexican population. Qual Quant. 2010;44(6):1105-12. http://doi.org/10.1007/s11135-009-9263-6
Aguilar-Navarro SG, Mimenza-Alvarado AJ, Avila-Funes JA, Juârez-Cedillo T, Bernal-Lôpez C, Hernândez-Favela CG. Clinical and demographic predictors of conversion to dementia in mexican elderly with mild cognitive impairment. Rev Invest CKn. 2017;69(1):33-9.
Gil L, Ruiz de Sánchez C, Gil F, Romero SJ, Pretelt Burgos F. Validation of the Montreal Cognitive Assessment (MoCA) in Spanish as a screening tool for mild cognitive impairment and mild dementia in patients over 65 years old in Bogotá, Colombia. Int J Geriatr Psychiatry . 2015;30(6):655-62. http://doi.org/10.1002/gps.4199
Pedraza OL, Sánchez E, Plata SJ, Montalvo C, Galvis P, Chiquillo A, Arévalo-Rodríguez I. Puntuaciones del MoCA y el MMSE en pacientes con deterioro cognitivo leve y demencia en una clínica de memoria en Bogotá. Acta Neurol Colomb. 2014;30(1):22-31.
Custodio N, García A, Montesinos R, Lira D, Bendezú L. Validación de la prueba de dibujo del reloj - versión de Manos - como prueba de cribado para detectar demencia en una población adulta mayor de Lima, Perú. Rev Peru Med Exp Salud Publica. 2011;28(1):29-34.
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