Diagnostic performance of brief cognitive tests in cognitive impairment screening

Selecting a Brief Cognitive Screening Test Based on Patient Profile: It Is Never Too Early to Start

Introduction: Cognitive impairment, marked by a decline in memory and attention, is frequently underdiagnosed, complicating effective management. Cardiovascular risk factors (CVR) and anticholinergic burden (ACB) are significant contributors to dementia risk, with ACB often stemming from medications prescribed for neuropsychiatric disorders. This study evaluates cognitive profiles through three brief cognitive tests, analyzing the impact of CVR and ACB presence. Methods: This cross-sectional study was performed between 2019 and 2023 in community pharmacies and an outpatient clinic in Valencia, Spain. Eligible participants were patients with subjective memory complaints 50 years or older with clinical records of cardiovascular factors. Patients with conflicting information regarding diabetes diagnosis or not taking concomitant medications were excluded. Three brief cognitive tests (Memory Impairment Screening (MIS), Semantic Verbal Fluency Test, and SPMSQ) were assessed. CVR was calculated using the European SCORE2 table, and ACB was assessed using the CALS scale. Results: Among 172 patients with memory complaints and CVR factors, 60% failed at least one cognitive test. These patients were on significantly more medications and had higher blood pressure and HbA1c levels. An increase in CVR and ACB was associated with more failed tests. Additionally, elevated SCORE2 scores were associated with a greater failure rate on the MIS test, while patients with elevated ACB more frequently failed the SPMSQ test. Conclusions: Selecting an adequate brief cognitive test according to patients' characteristics offers an opportunity to screen patients who are probably cognitively impaired. Whereas the MIS test may be helpful for patients with cardiovascular risk, SPMSQ stands out among patients with significant ACB.

FORTCARE-MCI study protocol: evaluation of Fortasyn Connect in the management of mild cognitive impairment in primary care

Background

Neuropsychiatric symptoms are prevalent in patients with mild cognitive impairment (MCI) and are predictive of the conversion to dementia. Fortasyn Connect, a medical food, has shown efficacy in managing cognitive and behavioral symptoms associated with MCI. Early diagnosis and intervention in primary care are essential for managing MCI. However, real-world prospective studies assessing Fortasyn Connect in MCI are still limited.

Methods

This observational, multicenter, prospective study will enroll 150 patients recently diagnosed with MCI by primary care physicians across several regions in Spain. Participants will be followed-up over a 12-month period, with assessments at baseline, 6 months, and 12 months, as per clinical practice. The study aims to evaluate the impact of Fortasyn Connect on neuropsychiatric symptoms, cognition, and health-related quality of life (HRQoL) using validated neuropsychological tests and machine learning (ML) techniques. The primary outcome measure will be changes in neuropsychiatric symptoms using the Neuropsychiatric Inventory Questionnaire (NPI-Q) at 6 months. Secondary outcome measures include further changes in the NPI-Q at 12 months, and changes in cognition (Fototest, and clock-drawing test) and HRQoL (EQ-5D-5L) at 6 and 12 months. Exploratory outcomes will assess speech using an artificial intelligence (AI)-enhanced ML tool, with a correlation analysis of these findings with traditional neuropsychological test results.

Conclusion

This study will provide evidence of the effectiveness of Fortasyn Connect in a real-world setting, exploring its potential to stabilize or improve neuropsychiatric symptoms, cognition, and HRQoL in MCI patients. Results will also contribute to the understanding of AI and ML in identifying early biomarkers of cognitive decline, supporting the timely management of MCI.

Comparative Performance of Five Cognitive Screening Tests in a Large Sample of Seniors

INTRODUCTION

Recent introductions of disease-modifying treatments for Alzheimer's disease have re-invigorated the cause of early dementia detection. Cognitive "paper and pencil" tests represent the bedrock of clinical assessment, because they are cheap, easy to perform, and do not require brain imaging or biological testing. Cognitive tests vary greatly in duration, complexity, sociolinguistic biases, probed cognitive domains, and their specificity and sensitivity of detecting cognitive impairment (CI). Consequently, an ecologically valid head-to-head comparison seems essential for evidence-based dementia screening.

METHOD

We compared five tests: Montreal cognitive assessment (MoCA), Alzheimer's disease assessment scale-cognitive subscale (ADAS), Addenbrooke's cognitive examination (ACE-III), euro-coin handling test (Eurotest), and image identification test (Phototest) on a large sample of seniors (N = 456, 77.9 ± 8 years, 71% females). Their specificity and sensitivity were estimated in a novel way by contrasting each test's outcome to the majority outcome across the remaining tests (comparative specificity and sensitivity calculation [CSSC]). This obviates the need for an a priori gold standard such as a clinically clear-cut sample of dementia/MCI/controls. We posit that the CSSC results in a more ecologically valid estimation of clinical performance while precluding biases resulting from different dementia/MCI diagnostic criteria and the proficiency in detecting these conditions.

RESULTS

There exists a stark trade-off between behavioral test specificity and sensitivity. The test with the highest specificity had the lowest sensitivity, and vice versa. The comparative specificities and sensitivities were, respectively: Phototest (97%, 47%), Eurotest (94%, 55%), ADAS (90%, 68%), ACE-III (72%, 77%), MoCA (55%, 95%).

CONCLUSION

Assuming a CI prevalence of 10%, the shortest (∼3 min) and the simplest instrument, the Phototest, was shown to have the best overall performance (accuracy 92%, PPV 66%, NPV 94%).