For Publishers
DiscoveryMetadataPeer reviewHostingPublishing
For Researchers
JoinPublishReviewCollect
Register
Blog
About
Search
Advanced search
My ScienceOpen
Search
For Publishers
For Researchers
Blog
About
35
views
11
references
 Top references
cited by
13
    
0 reviews
 Review
0
comments
 Comment
0
recommends
+1 Recommend
1 collections
    0
    shares
      261
      similar
       All similar

      Call for Papers: Sex and Gender in Neurodegenerative Diseases

      Submit here before September 30, 2024

      About Neurodegenerative Diseases: 3.0 Impact Factor I 4.3 CiteScore I 0.695 Scimago Journal & Country Rank (SJR)

      • Record: found
      • Abstract: found
      • Article: found

      Optimising the Cutoffs of Cognitive Screening Instruments in Pragmatic Diagnostic Accuracy Studies: Maximising Accuracy or the Youden Index?

      research-article

      Read this article at

      ScienceOpenPublisherPubMed
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background/Aims: The optimal method of establishing test cutoffs or cutpoints for cognitive screening instruments (CSIs) is uncertain. Of the available methods, two base cutoffs on either the maximal test accuracy or the maximal Youden index. The aim of this study was to compare the effects of using these alternative methods of establishing cutoffs. Methods: Datasets from three pragmatic diagnostic accuracy studies which examined the Mini-Mental State Examination (MMSE), the Addenbrooke's Cognitive Examination-Revised (ACE-R), the Montreal Cognitive Assessment (MoCA), and the Test Your Memory (TYM) test were analysed to calculate test sensitivity and specificity using cutoffs based on either maximal test accuracy or the maximal Youden index. Results: For ACE-R, MoCA, and TYM, optimal cutoffs for dementia diagnosis differed from those in index studies when defined using either the maximal accuracy or the maximal Youden index method. Optimal cutoffs were higher for MMSE, MoCA, and TYM when using the maximal Youden index method and consequently more sensitive. Conclusion: Revision of the cutoffs for CSIs established in index studies may be required to optimise performance in pragmatic diagnostic test accuracy studies which more closely resemble clinical practice.

          Related collections

          Most cited references11

          • Record: found
          • Abstract: found
          • Article: not found

          Screening utility of the Montreal Cognitive Assessment (MoCA): in place of--or as well as--the MMSE?

          A Larner (2012)
          This aim of this study was to assess the clinical utility of the Montreal Cognitive Assessment (MoCA) as a screening instrument for cognitive impairment in patients referred to a memory clinic, alone and in combination with the Mini-Mental State Examination (MMSE). This was a pragmatic prospective study of consecutive referrals attending a memory clinic (n = 150) over an 18-month period. Patients were diagnosed using standard clinical diagnostic criteria for dementia (DSM-IV) and mild cognitive impairment (MCI; cognitive impairment prevalence = 43%) independent of MoCA test scores. MoCA proved acceptable to patients and was quick and easy to use. Using the cut-offs for MoCA and MMSE specified in the index paper (≥26/30), MoCA was more sensitive than MMSE (0.97 vs 0.65) but less specific (0.60 vs 0.89), with better diagnostic accuracy (area under Receiver Operating Characteristic curve 0.91 vs 0.83). Downward adjustment of the MoCA cut-off to ≥20/30 maximized test accuracy and improved specificity (0.95) for some loss of sensitivity (0.63). Combining MoCA with the MMSE - either in series or in parallel - did not improve diagnostic utility above that with either test alone. In a memory clinic population, MoCA proved sensitive for the diagnosis of cognitive impairment. Use of a cut-off lower than that specified in the index study may be required to improve overall test accuracy and specificity for some loss of sensitivity in populations with a high prior probability of cognitive impairment. Combining the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) with the MMSE did not improve diagnostic utility.
          Article 0 comments Cited 73 times – based on 0 reviews     Review now
            Bookmark
            • Record: found
            • Abstract: found
            • Article: found
            Is Open Access

            Self administered cognitive screening test (TYM) for detection of Alzheimer’s disease: cross sectional study

            Jeremy Brown, George Pengas, Kate Dawson … (2009)
            Objective To evaluate a cognitive test, the TYM (“test your memory”), in the detection of Alzheimer’s disease. Design Cross sectional study. Setting Outpatient departments in three hospitals, including a memory clinic. Participants 540 control participants aged 18-95 and 139 patients attending a memory clinic with dementia/amnestic mild cognitive impairment. Intervention Cognitive test designed to use minimal operator time and to be suitable for non-specialist use. Main outcome measures Performance of normal controls on the TYM. Performance of patients with Alzheimer’s disease on the TYM compared with age matched controls. Validation of the TYM with two standard tests (the mini-mental state examination (MMSE) and the Addenbrooke’s cognitive examination-revised (ACE-R)). Sensitivity and specificity of the TYM in the detection of Alzheimer’s disease. Results Control participants completed the TYM with an average score of 47/50. Patients with Alzheimer’s disease scored an average of 33/50. The TYM score shows excellent correlation with the two standard tests. A score of ≤42/50 had a sensitivity of 93% and specificity of 86% in the diagnosis of Alzheimer’s disease. The TYM was more sensitive in detection of Alzheimer’s disease than the mini-mental examination, detecting 93% of patients compared with 52% for the mini-mental state exxamination. The negative and positive predictive values of the TYM with the cut off of ≤42 were 99% and 42% with a prevalence of Alzheimer’s disease of 10%. Thirty one patients with non-Alzheimer dementias scored an average of 39/50. Conclusions The TYM can be completed quickly and accurately by normal controls. It is a powerful and valid screening test for the detection of Alzheimer’s disease.
            Article 0 comments Cited 65 times – based on 0 reviews     Review now
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              The STARD Statement for Reporting Studies of Diagnostic Accuracy: Explanation and Elaboration

              Patrick Bossuyt, Johannes Reitsma, David Bruns … (2003)
              The quality of reporting of studies of diagnostic accuracy is less than optimal. Complete and accurate reporting is necessary to enable readers to assess the potential for bias in the study and to evaluate the generalisability of the results. A group of scientists and editors has developed the STARD (Standards for Reporting of Diagnostic Accuracy) statement to improve the reporting the quality of reporting of studies of diagnostic accuracy. The statement consists of a checklist of 25 items and flow diagram that authors can use to ensure that all relevant information is present. This explanatory document aims to facilitate the use, understanding and dissemination of the checklist. The document contains a clarification of the meaning, rationale and optimal use of each item on the checklist, as well as a short summary of the available evidence on bias and applicability. The STARD statement, checklist, flowchart and this explanation and elaboration document should be useful resources to improve reporting of diagnostic accuracy studies. Complete and informative reporting can only lead to better decisions in healthcare.
              Article 0 comments Cited 51 times – based on 0 reviews     Review now
                Bookmark
                All references

                Author and article information

                Journal
                Journal ID (publisher-id): DEM
                Journal ID (nlm-ta): Dement Geriatr Cogn Disord
                Journal ID (doi): 10.1159/issn.1420-8008
                Title: Dementia and Geriatric Cognitive Disorders
                Publisher: S. Karger AG
                ISSN (Print): 1420-8008
                ISSN (Electronic): 1421-9824
                Publication date Subscription-year: 2015
                Publication date (Print): February 2015
                Publication date (Electronic): 06 January 2015
                Volume: 39
                Issue: 3-4
                Pages: 167-175
                Affiliations
                Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Liverpool, UK
                Author notes
                *A.J. Larner, Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Lower Lane, Fazakerley, Liverpool L9 7LJ (UK), E-Mail a.larner@thewaltoncentre.nhs.uk
                Article
                Publisher ID: 369883 Other ID: Dement Geriatr Cogn Disord 2015;39:167-175
                DOI: 10.1159/000369883
                PubMed ID: 25572277
                SO-VID: f85d096a-aecd-4aa0-aa4b-c7dab2faff94
                Copyright © © 2015 S. Karger AG, Basel
                License:

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                Date accepted : 13 November 2014
                Page count
                Tables: 7, References: 22, Pages: 9
                Categories
                Subject: Original Research Article

                ScienceOpen disciplines: Geriatric medicine,Neurology,Cardiovascular Medicine,Neurosciences,Clinical Psychology & Psychiatry,Public health
                Keywords: Addenbrookeߣs Cognitive Examination-Revised,Diagnostic accuracy, Youden index,Test Your Memory test,Mini-Mental State Examination,Montreal Cognitive Assessment,Cutoff
                Data availability:
                ScienceOpen disciplines: Geriatric medicine, Neurology, Cardiovascular Medicine, Neurosciences, Clinical Psychology & Psychiatry, Public health
                Keywords: Addenbrookeߣs Cognitive Examination-Revised, Diagnostic accuracy, Youden index, Test Your Memory test, Mini-Mental State Examination, Montreal Cognitive Assessment, Cutoff

                Comments

                Comment on this article

                scite_

                Similar content261

                See all similar

                Cited by13

                See all cited by

                Most referenced authors662

                See all reference authors