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. 2018 Feb 22;2(2):CD011415.
doi: 10.1002/14651858.CD011415.pub2.

Mini-Cog for the diagnosis of Alzheimer's disease dementia and other dementias within a primary care setting

Dallas P Seitz  1 , Calvin Ch Chan, Hailey T Newton, Sudeep S Gill, Nathan Herrmann, Nadja Smailagic, Vasilis Nikolaou, Bruce A Fage
Affiliations

Mini-Cog for the diagnosis of Alzheimer's disease dementia and other dementias within a primary care setting

Dallas P Seitz et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Alzheimer's disease and other forms of dementia are becoming increasingly common with the aging of most populations. The majority of individuals with dementia will first present for care and assessment in primary care settings. There is a need for brief dementia screening instruments that can accurately diagnose dementia in primary care settings. The Mini-Cog is a brief, cognitive screening test that is frequently used to evaluate cognition in older adults in various settings.

Objectives: To determine the diagnostic accuracy of the Mini-Cog for diagnosing Alzheimer's disease dementia and related dementias in a primary care setting.

Search methods: We searched the Cochrane Dementia and Cognitive Improvement Register of Diagnostic Test Accuracy Studies, MEDLINE, Embase and four other databases, initially to September 2012. Since then, four updates to the search were performed using the same search methods, and the most recent was January 2017. We used citation tracking (using the databases' 'related articles' feature, where available) as an additional search method and contacted authors of eligible studies for unpublished data.

Selection criteria: We only included studies that evaluated the Mini-Cog as an index test for the diagnosis of Alzheimer's disease dementia or related forms of dementia when compared to a reference standard using validated criteria for dementia. We only included studies that were conducted in primary care populations.

Data collection and analysis: We extracted and described information on the characteristics of the study participants and study setting. Using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) criteria we evaluated the quality of studies, and we assessed risk of bias and applicability of each study for each domain in QUADAS-2. Two review authors independently extracted information on the true positives, true negatives, false positives, and false negatives and entered the data into Review Manager 5 (RevMan 5). We then used RevMan 5 to determine the sensitivity, specificity, and 95% confidence intervals. We summarized the sensitivity and specificity of the Mini-Cog in the individual studies in forest plots and also plotted them in a receiver operating characteristic plot. We also created a 'Risk of bias' and applicability concerns graph to summarize information related to the quality of included studies.

Main results: There were a total of four studies that met our inclusion criteria, including a total of 1517 total participants. The sensitivity of the Mini-Cog varied between 0.76 to 1.00 in studies while the specificity varied between 0.27 to 0.85. The included studies displayed significant heterogeneity in both methodologies and clinical populations, which did not allow for a meta-analysis to be completed. Only one study (Holsinger 2012) was found to be at low risk of bias on all methodological domains. The results of this study reported that the sensitivity of the Mini-Cog was 0.76 and the specificity was 0.73. We found the quality of all other included studies to be low due to a high risk of bias with methodological limitations primarily in their selection of participants.

Authors' conclusions: There is a limited number of studies evaluating the accuracy of the Mini-Cog for the diagnosis of dementia in primary care settings. Given the small number of studies, the wide range in estimates of the accuracy of the Mini-Cog, and methodological limitations identified in most of the studies, at the present time there is insufficient evidence to recommend that the Mini-Cog be used as a screening test for dementia in primary care. Further studies are required to determine the accuracy of Mini-Cog in primary care and whether this tool has sufficient diagnostic test accuracy to be useful as a screening test in this setting.

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Conflict of interest statement

DS: no conflicts of interest to declare CC: no conflicts of interest to declare SG: no conflicts of interest to declare NH: no conflicts of interest to declare NS: no conflicts of interest to declare VN: no conflicts of interest to declare BF: no conflicts of interest to declare

Figures

1
1
Study flow diagram
2
2
Risk of bias and applicability concerns graph: review authors' judgements about each domain presented as percentages across included studies
3
3
Risk of bias and applicability concerns summary: review authors' judgements about each domain for each included study
4
4
Forest plot of Analysis 1 Mini‐Cog
1
1. Test
Mini‐Cog.
See this image and copyright information in PMC

References

References to studies included in this review

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Ketelaars 2013 {published and unpublished data}
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Mion 2014 {published and unpublished data}
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Perez‐Mojica 2014 {published data only}
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Petrazzuoli 2013 {published and unpublished data}
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Pudlo 2016 {published data only}
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Rosenbloom 2014 {published data only}
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Setter 2009 {published data only}
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Sinclair 2013 {published and unpublished data}
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Singla 2016 {published data only}
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Skibitsky 2016 {published data only}
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Slater 2013 {published data only}
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Steenland 2008 {published data only}
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Trowbridge 2014 {published data only}
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Trowbridge 2016 {published data only}
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Vega 2016 {published data only}
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