Decline in cognition from mid-life improves specificity of mini-mental state examination: diagnostic test accuracy in Caerphilly Prospective Study (CaPs)

Creavin, Sam, Fish, Mark, Bayer, Antony ORCID: https://orcid.org/0000-0002-7514-248X, Gallacher, John and Ben-Shlomo, Yoav 2022. Decline in cognition from mid-life improves specificity of mini-mental state examination: diagnostic test accuracy in Caerphilly Prospective Study (CaPs). Journal of Alzheimer's Disease 89 (4) , pp. 1241-1248. 10.3233/JAD-220345

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Abstract

Background:The merit of using baseline cognitive assessments in mid-life to help interpret cross-sectional cognitive tests scores in later life is uncertain. Objective:Evaluate how accuracy for diagnosing dementia is enhanced by comparing cross-sectional results to a midlife measure. Methods:Cohort study of 2,512 men with repeated measures of Mini-Mental State Examination (MMSE) over approximately 10 years. Index test MMSE at threshold of 24 indicating normal, as a cross-sectional measure and in combination with decline in MMSE score from mid-life. Reference standard consensus clinical diagnosis of dementia by two clinicians according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Results:1,150 men participated at phase 4 of whom 75 had dementia. A cross-sectional MMSE alone produced a sensitivity of 60% (50% to 70%) and specificity 95% (94% to 97%) with a threshold of≥24 points indicating normal. For lower-scoring men in late life, with cross sectional scores of < 22, combining cross-sectional AND a three-point or more decline over time had a sensitivity of 52% (39% to 64%) and specificity 99% (99% to 100%). For higher-scoring men in later life, with cross sectional scores < 26 combining cross-sectional OR decline of at least three points had a sensitivity of 98% (92% to 100%) and specificity 38% (32% to 44%). Conclusion:It may be helpful in practice to formally evaluate cognition in mid-life as a baseline to compare with if problems develop in future, as this may enhance diagnostic accuracy and classification of people in later life.

Item Type:	Article
Date Type:	Published Online
Status:	Published
Schools:	Medicine
Publisher:	IOS Press
ISSN:	1387-2877
Date of First Compliant Deposit:	20 January 2023
Date of Acceptance:	25 July 2022
Last Modified:	27 Nov 2024 20:45
URI:	https://orca.cardiff.ac.uk/id/eprint/156129

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