A Systematic Review of Cognitive Screening for Mild Cognitive Impairment

Review Article

A Systematic Review of Cognitive Screening for Mild Cognitive Impairment

Jane A Lonie¹, Ukwuori G Kalu² and Klaus P Ebmeier^1,2
Affiliations: ¹Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK and ²Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK



ABSTRACT

Background:
Although patients with mild cognitive impairment (MCI) make up a significant proportion of outpatient and memory clinic visits in old age psychiatry, their cognitive evaluation is typically restricted to brief dementia screens. We present an evaluation of published cognitive screens in MCI, their validity, and utility.
Method:
Papers published after Petersen’s original MCI criteria were identified with 10 library search engines, combining the search terms “mild cognitive impairment” and “cognitive screening”, as well as “mild cognitive impairment” and the names of 39 screening tests recently identified in a relevant review.
Results:
Twenty‐six relevant publications were identified, of which seven summarized the sensitivity and specificity of four comprehensive screening tests, and 19 evaluated 11 non‐comprehensive tests. A recently published meta‐analysis of the use of the mini‐mental state examination summarized five mild cognitive impairment studies. Sensitivities over 80% for detecting MCI among healthy volunteers were reported for all four comprehensive and three of the 11 non‐comprehensive screening tests. Equivalent specificity values over 80% could be found for two comprehensive and five non‐comprehensive tests. With the exception of six studies, MCI study sample sizes were universally small (i.e., n≤100), and prognostic values were reported for only two of the identified 15 screening measures.
Conclusions:
Sensitivities of the full domain measures were universally high, but information about their specificity against psychiatric and non‐progressive neurological conditions and predictive validity is largely lacking. Conversely, non‐comprehensive screening tests appear to be less accurate overall, with relatively greater specificity and lesser sensitivity.

Keywords: systematic review, screening, mild cognitive impairment, dementia, Alzheimer’s disease, differential diagnosis, neuropsychology

Correspondence: K P Ebmeier, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK. e‐mail: Klaus.ebmeier@psych.ox.ac.uk