Evaluation of the Accuracy of Cognitive Screening Tests in Detecting Dementia Associated with Alzheimer’s Disease: A Hierarchical Bayesian Latent Class Meta-Analysis

Article type: Research Article

Authors: Wang, Xiaonan^{a; b} | Li, Fengjie^{a; b} | Gao, Qi^{a; b} | Jiang, Zhen^{a; b} | Abudusaimaiti, Xiayidanmu^{a; b} | Yao, Jiangyue^{a; b} | Zhu, Huiping^{a; b; *}

Affiliations: [a] Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, P.R. China | [b] Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, P. R. China

Correspondence: [*] Correspondence to: Huiping Zhu, PhD, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No. 10, Xi Toutiao You Anmenwai, Beijing 100069, China. Tel.: +010 83911777; E-mail: zhuhuiping@ccmu.edu.cn.

Abstract: Background:Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) are neuropsychological tests commonly used by physicians for screening cognitive dysfunction of Alzheimer’s disease (AD). Due to different imperfect reference standards, the performance of MoCA and MMSE do not reach consensus. It is necessary to evaluate the consistence and differentiation of MoCA and MMSE in the absence of a gold standard for AD. Objective:We aimed to assess the accuracy of MoCA and MMSE in screening AD without a gold standard reference test. Methods:Studies were identified from PubMed, Web of Science, CNKI, Chinese Wanfang Database, China Science and Technology Journal Database, and Cochrane Library. Our search was limited to studies published in English and Chinese before August 2021. A hierarchical Bayesian latent class model was performed in meta-analysis when the gold standard was absent. Results:A total of 67 studies comprising 5,554 individuals evaluated for MoCA and 76,862 for MMSE were included in this meta-analysis. The pooled sensitivity was 0.934 (95% CI 0.905 to 0.954) for MoCA and 0.883 (95% CI 0.859 to 0.903) for MMSE, while the pooled specificity was 0.899 (95% CI 0.859 to 0.928) for MoCA and 0.903 (95% CI 0.879 to 0.923) for MMSE. MoCA was useful to rule out dementia associated with AD with lower negative likelihood ratio (LR-) (0.074, 95% CI 0.051 to 0.108). MoCA showed better performance with higher diagnostic odds ratio (DOR) (124.903, 95% CI 67.459 to 231.260). Conclusion:MoCA had better performance than MMSE in screening dementia associated with AD from patients with mild cognitive impairment or healthy controls.

Keywords: Alzheimer’s disease, meta-analysis, Mini-Mental State Examination, Montreal Cognitive Assessment, sensitivity, specificity

DOI: 10.3233/JAD-215394

Journal: Journal of Alzheimer's Disease, vol. 87, no. 1, pp. 285-304, 2022