title: Cognitive screening for dementia and mild cognitive impairment in assisted living: comparison of 3 tests.
abstract: OBJECTIVE
  Compare diagnostic characteristics of brief cognitive screening tests in residential care/assisted living (RC/AL) residents.
  
  
  METHODS
  Cross-sectional study involving a comprehensive clinical examination to ascertain a consensus diagnosis of probable dementia, no significant cognitive impairment, or mild cognitive impairment (MCI), including both amnestic and non-amnestic subtypes.
  
  
  METHODS
  Fourteen RC/AL facilities in North Carolina.
  
  
  METHODS
  Participants were 146 RC/AL residents, aged 65 years or older, who did not have diagnosed cognitive impairment.
  
  
  METHODS
  Diagnostic characteristics of the Mini-Cog, the Mini-Mental State Exam (MMSE), and a new 50-point test based on expanding selected MMSE items (MMX).
  
  
  RESULTS
  Overall, 55/146 (38%) participants were diagnosed with probable dementia, and 76 (52%) met criteria for MCI (most non-amnestic). Both the Mini-Cog and the MMSE showed high sensitivity and negative predictive value for dementia, but had relatively low sensitivity and negative predictive value for MCI. The Mini-Cog had low specificity and was less accurate as a dementia screen than either the MMSE or MMX. Reliability and validity data for the MMX were satisfactory, and it performed better as a screening test for MCI than either the MMSE or Mini-Cog.
  
  
  CONCLUSIONS
  Although the MMSE and Mini-Cog are both sensitive to dementia, modest specificity and positive predictive value may limit their utility as screening tools. Preliminary MMX data suggest it improves screening for MCI compared to the Mini-Cog or MMSE, while providing a similar level of screening for dementia. Further work is needed to identify suitable instruments for cognitive screening across the range of MCI and dementia.
authors.affiliation: Department of Neurology, School of Medicine, University of North Carolina at Chapel Hill, NC 27599 -7025, USA. kauferd@neurology.unc.edu
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Kaufer
authors.forename: Christianna S
authors.initials: CS
authors.lastname: Williams
authors.forename: Alyssa J
authors.initials: AJ
authors.lastname: Braaten
authors.forename: Karminder
authors.initials: K
authors.lastname: Gill
authors.forename: Sheryl
authors.initials: S
authors.lastname: Zimmerman
authors.forename: Philip D
authors.initials: PD
authors.lastname: Sloane
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D040561:Assisted Living Facilities; D003071:Cognition; D003704:Dementia / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008485:Medical Audit; D009657:North Carolina; D011795:Surveys and Questionnaires