However, it is not yet clear which tests are sensitive and specific enough to detect AD in an early phase. There are already a wide variety of alternative screening instruments in circulation. In agreement with Mitchell’s results, some reviews suggest to replace the MMSE by more performant alternatives. However, Mitchell concluded after a meta-analysis that the MMSE has a very limited ability to differentiate between MCI and healthy controls. At present, the most used cognitive screening instrument for the detection of AD is the Mini-Mental State Examination (MMSE ). The same holds true for clinical trials with potential disease-modifying drugs for AD that increasingly focus on the earliest stages of the disease.Ĭognitive screening instruments are cheap, fast, and non-invasive tools to identify adults at risk to have symptomatic AD. For an effective intervention (including counseling, psycho-education, cognitive training, medication), early detection of the disease is important. The process of AD pathology can be described as a continuum with a long preclinical phase without clinical symptoms, an early clinical phase in which mild clinical symptoms (mild cognitive impairment (MCI) or prodromal AD) are present, and a dementia phase. It is therefore not surprising that more and more people (will) develop age-related diseases such as Alzheimer’s disease (AD). This will probably increase to 23.1% in 2030. According to the United Nations in 2015, 17.6% of the European population was older than 65 years. The aging population in Europe has been growing rapidly. The MoCA is a promising instrument, but the specificity to detect early AD is rather low. Especially, computer tests require further research. However, most tests are only validated in a memory clinic setting and description of the psychometric properties of the instruments is limited. ConclusionsĪ large number of screening tests for AD are available. Regarding computer tests, validation studies were only available for 7 out of 12 tests. Based on the number of studies (31 articles) and the sensitivity (84%) and specificity (74%) values, the Montreal Cognitive Assessment (MoCA) seems to be a promising (pencil and paper) screening test for memory clinic testing as well as for population screening. Eighty-nine papers discussed pencil and paper tests of which 80 were validated in a memory clinic setting. Out of 1454 papers, 96 clearly discussed the psychometric properties of the instruments. Therefore, the same databases were searched again to identify papers that described the psychometric properties of the instruments meanwhile applying diagnostic criteria for the diagnostic groups included. In a second step, the psychometric quality of these instruments was evaluated. All full-text papers about cognitive screening instruments for the early detection of AD were included, resulting in the identification of 38 pencil and paper tests and 12 computer tests. Only papers written in English or Dutch were considered. Methodsįirst, a systematic search of titles and abstracts of PubMed and Web of Science was conducted between February and July 2015 and updated in April 2016 and May 2018. The objective of this systematic review was (1) to give an overview of the available short screening instruments for the early detection of Alzheimer’s disease (AD) and (2) to review the psychometric properties of these instruments.
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