title: Dementia=(MC)2: a 4-item screening test for mild cognitive impairment and dementia.
abstract: To develop a practical informant-based screening tool that reliably identifies patients with mild cognitive impairment (MCI) and dementia, we analyzed data from a sample of patients and normal controls seen in a memory clinic. All patients were evaluated with the Clinical Dementia Rating scale. Individual Clinical Dementia Rating responses were dichotomized and entered into a forward stepwise multivariable logistic regression model. Four independent predictors of MCI and dementia thus identified were combined into a prediction rule that was validated in a separate cohort drawn from the same clinic. Using a cut point of 2 or more positive responses to the 4 questions, the final prediction rule had sensitivity of 95% (95% confidence interval (CI): 92-97%) for MCI or dementia, and a specificity of 91% (95% CI: 86-95%). When applied to the validation cohort, the sensitivity for MCI or dementia was 96% (95% CI: 94-98%), and the specificity was 96% (95% CI: 92-98%). Using both cohorts, the positive likelihood ratio for MCI or dementia was 15.6 (95% CI: 14.0-17.3) and the negative likelihood ratio was 0.05 (95% CI: 0.04-0.07). This tool has the potential to identify patients who warrant further cognitive evaluation in busy outpatient or emergency department settings.
authors.affiliation: UCSF Department of Neurology, San Francisco, CA 94143-0114, USA. vanja.douglas@ucsf.edu
authors.forename: Vanja C
authors.initials: VC
authors.lastname: Douglas
authors.forename: John
authors.initials: J
authors.lastname: Neuhaus
authors.forename: Julene K
authors.initials: JK
authors.lastname: Johnson
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Racine
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Miller
authors.forename: Scott Andrew
authors.initials: SA
authors.lastname: Josephson
mesh_terms: D000368:Aged; D019540:Area Under Curve; D060825:Cognitive Dysfunction / Q000175:diagnosis*; D003704:Dementia / Q000175:diagnosis*; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales; D012372:ROC Curve