Improving detection of dementia in Asian patients with low education: combining the Mini-Mental State Examination and the Informant Questionnaire on Cognitive Decline in the Elderly.
OBJECTIVE
Previous work combining the Mini-Mental State Examination (MMSE) and Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) has been conducted in western populations. We ascertained, in an Asian population, (1) the best method of combining the tests, (2) the effects of educational level, and (3) the effect of different dementia etiologies.


METHODS
Data from 576 patients were analyzed (407 nondemented controls, 87 Alzheimer's disease and 82 vascular dementia patients). Sensitivity, specificity and AUC values were obtained using three methods, the 'And' rule, the 'Or' rule, and the 'weighted sum' method.


RESULTS
The 'weighted sum' rule had statistically superior AUC and specificity results, while the 'Or' rule had the best sensitivity results. The IQCODE outperformed the MMSE in all analyses. Patients with no education benefited more from combined tests. There was no difference between Alzheimer's disease and vascular dementia populations in the predictive value of any of the combined methods.


CONCLUSIONS
We recommend that the IQCODE be used to supplement the MMSE whenever available and that the 'weighted sum' method be used to combine the MMSE and the IQCODE, particularly in populations with low education. As the study population selected may not be representative of the general population, further studies are required before generalization to nonclinical samples.
Narasimhalu
Kaavya
K
Center for Molecular Epidemiology, National University of Singapore, Singapore, Singapore. nkaavya@gmail.com
Lee
June
J
Auchus
Alexander P
AP
Chen
Christopher P L H
CP
D000368:Aged; D044466:Asian People / Q000706:statistics & numerical data*; D003072:Cognition Disorders / Q000175:diagnosis* / Q000208:ethnology*; D003704:Dementia / Q000175:diagnosis* / Q000208:ethnology*; D003710:Demography; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D009483:Neuropsychological Tests; D015995:Prevalence; D012846:Singapore / Q000453:epidemiology; D011795:Surveys and Questionnaires