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P2‐124: Clinical assessment of Asians with subjective memory complaints: The Chinese Mini‐Mental State Examination lacks sensitivity in the mild end of the disease spectrum
Author(s) -
Chan Mark,
Yeo Ying Ying,
Chong Mei Sian
Publication year - 2010
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2010.05.1171
Subject(s) - clinical dementia rating , dementia , neuropsychology , receiver operating characteristic , mini–mental state examination , medicine , cohort , neuropsychological test , psychology , cognition , psychiatry , disease
Background: With increasing emphasis on the early identification of cognitive impairment, it is imperative that screening tools are evaluated for their discriminating properties in the mild end of the disease spectrum. We aimed to assess the validity and diagnostic utility of the Chinese Mini-Mental State Examination (CMMSE) when applied to subjects with early cognitive complaints in an Asian memory clinic setting. Methods: 206 subjects with no dementia (ND, n 1⁄4 44), mild cognitive impairment (MCI, n 1⁄4 50), and mild dementia (n 1⁄4 112) presenting over a 2.5year period were reviewed. MCI subjects were operationally defined as global Clinical Dementia Rating (CDR) score of 0.5, at least one domain >1SD impairment upon neuropsychological testing and functional abilities preserved while mild dementia subjects had a global CDR of 0.5 or 1.0 and fulfilled standardized criteria for dementia diagnosis. Correlations of CMMSE with global {CDR-sum of boxes score (CDR-SB)}, functional {Lawton’s scale for instrumental activities of daily living (iADL)} and neuropsychological (neuropsychological test battery composite score) measures were examined, while receiver operating characteristic (ROC) curves were used to determine optimal cut-offs and corresponding sensitivity (Sn), specificity (Sp) and area-under-curve (AUC). Results: Subjects were predominantly elderly (mean age 1⁄4 72.5 6 8.6 years), female (55.3%) and Chinese (88.8%). CMMSE had significant but modest correlations with CDR-SB, iADL and neuropsychological test performance (Pearson’s R 1⁄4 -0.61, 0.47 and 0.55 respectively, all p < 0.001). The AUC, Sn and Sp for the entire cohort were 0.85, 75.0% and 80.9% respectively, with an optimum cut-off score to exclude dementia of 25. The best test performance were obtained for subjects with higher educational attainment (AUC, Sn and Sp 1⁄4 0.87, 83.3% and 80.3% respectively), and worst when only ND and MCI subjects with less than 6 years of education were considered (0.67, 64.3% and 73.3% respectively). Conclusions: Despite higher cut-offs, the sensitivity and specificity of CMMSE for the detection of MCI and mild dementia were substantially lower than previously reported values based on the evaluation of mild dementia alone. Screening of subjects with early cognitive complaints using the CMMSE must be supplemented with neuropsychological testing and other biomarkers to augment its diagnostic yield.