Development of a Rapid Screening Instrument for Mild Cognitive Impairment and Undiagnosed Dementia

Article type: Research Article

Authors: Steenland, N. Kyle^{a; **} | Auman, Courtney M.^b | Patel, Purvi M.^a | Bartell, Scott M.^c | Goldstein, Felicia C.^d | Levey, Allan I.^d | Lah, James J.^{d; *}

Affiliations: [a] Department of Environmental and Occupational Health, School of Public Health, Emory University, Atlanta, GA, USA | [b] School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA | [c] Department of Epidemiology, School of Medicine, University of California-Irvine, Irvine, CA, USA | [d] Department of Neurology, School of Medicine, Emory University, Atlanta, GA, USA

Correspondence: [*] Corresponding author: James J. Lah, M.D., Ph.D., Center for Neurodegenerative Disease, 615 Michael St., Suite 505C, Atlanta, GA 30322, USA. Tel.: +1 404 727 3727; Fax: +1 404 727 3728; E-mail: jlah@emory.edu.

Correspondence: [**] Alternate corresponding author: Kyle Steenland, Ph.D., Environmental and Occupational Health, 1518 Clifton Rd., Atlanta, GA 30322, USA. Tel.: +1 404 712 8277; Fax: +1 404 727 8744; E-mail: nsteenl@sph.emory.edu.

Abstract: Mild cognitive impairment (MCI) often presages development of Alzheimer's disease (AD). We recently completed a cross-sectional study to test the hypothesis that a combination of a brief cognitive screening instrument (Mini-Cog) with a functional scale (Functional Activities Questionnaire; FAQ) would accurately identify individuals with MCI and undiagnosed dementia. The Mini-Cog consists of a clock drawing task and 3-item recall, and takes less than 5 minutes to administer. The FAQ is a 30-item questionnaire completed by an informant. In addition to the Mini-Cog and FAQ, a traditional cognitive test battery was administered, and two neurologists and a neuropsychologist determined a consensus diagnosis of Normal, MCI, or Dementia. A classification tree algorithm was used to pick optimal cutpoints, and, using these cutpoints, the combined Mini-Cog and FAQ (MC-FAQ) predicted the consensus diagnosis with an accuracy of 83% and a weighted kappa of 0.81. When the population was divided into Normal and Abnormal, the sensitivity, specificity and positive predictive value were 89%, 90%, and 95%, respectively. The MC-FAQ discriminates individuals with MCI from cognitively normal individuals and those with dementia, and its ease of administration makes it an attractive screening instrument to aid detection of cognitive impairment in the elderly.

Keywords: Cognitive screening, dementia, Functional Activities Questionnaire, mild cognitive impairment, Mini-Cog

DOI: 10.3233/JAD-2008-15308

Journal: Journal of Alzheimer's Disease, vol. 15, no. 3, pp. 419-427, 2008