Date Published: February 28, 2019
Publisher: BioMed Central
Author(s): Ellen Elisa De Roeck, Peter Paul De Deyn, Eva Dierckx, Sebastiaan Engelborghs.
The objective of this systematic review was (1) to give an overview of the available short screening instruments for the early detection of Alzheimer’s disease (AD) and (2) to review the psychometric properties of these instruments.
First, a systematic search of titles and abstracts of PubMed and Web of Science was conducted between February and July 2015 and updated in April 2016 and May 2018. Only papers written in English or Dutch were considered. All full-text papers about cognitive screening instruments for the early detection of AD were included, resulting in the identification of 38 pencil and paper tests and 12 computer tests. In a second step, the psychometric quality of these instruments was evaluated. Therefore, the same databases were searched again to identify papers that described the psychometric properties of the instruments meanwhile applying diagnostic criteria for the diagnostic groups included.
Out of 1454 papers, 96 clearly discussed the psychometric properties of the instruments. Eighty-nine papers discussed pencil and paper tests of which 80 were validated in a memory clinic setting. Based on the number of studies (31 articles) and the sensitivity (84%) and specificity (74%) values, the Montreal Cognitive Assessment (MoCA) seems to be a promising (pencil and paper) screening test for memory clinic testing as well as for population screening. Regarding computer tests, validation studies were only available for 7 out of 12 tests.
A large number of screening tests for AD are available. However, most tests are only validated in a memory clinic setting and description of the psychometric properties of the instruments is limited. Especially, computer tests require further research. The MoCA is a promising instrument, but the specificity to detect early AD is rather low.
The online version of this article (10.1186/s13195-019-0474-3) contains supplementary material, which is available to authorized users.
The aging population in Europe has been growing rapidly. According to the United Nations in 2015, 17.6% of the European population was older than 65 years. This will probably increase to 23.1% in 2030. It is therefore not surprising that more and more people (will) develop age-related diseases such as Alzheimer’s disease (AD). The process of AD pathology can be described as a continuum with a long preclinical phase without clinical symptoms, an early clinical phase in which mild clinical symptoms (mild cognitive impairment (MCI) or prodromal AD) are present, and a dementia phase [1–3]. For an effective intervention (including counseling, psycho-education, cognitive training, medication), early detection of the disease is important . The same holds true for clinical trials with potential disease-modifying drugs for AD that increasingly focus on the earliest stages of the disease.
This review consists of two parts. First, a systematic search for relevant screening instruments was performed. Second, a search was carried out to identify the psychometric properties of these screening instruments.
The aims of this review were to identify and evaluate available screening instruments for early detection of AD and MCI. As mentioned in the introduction, not for every setting the same tests are appropriate. Therefore, we will discuss briefly two general findings and subsequently discuss the applicability of the different cognitive screens in different settings.