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Cognitive screening tools for identification of dementia in illiterate and low-educated older adults, a systematic review and meta-analysis
Paddick SM, Gray WK, McGuire J, Richardson J, Dotchin C, Walker RW.. International psychogeriatrics, 2017-03-09
Topic: Risk, prevention and care in population studies
Background The majority of older adults with dementia live in low- and middle-income countries (LMICs). Illiteracy and low educational background are common in older LMIC populations, particularly in rural areas, and cognitive screening tools developed for this setting must reflect this. This study aimed to review published validation studies of cognitive screening tools for dementia in low-literacy settings in order to determine the most appropriate tools for use. Method A systematic search of major databases was conducted according to PRISMA guidelines. Validation studies of brief cognitive screening tests including illiterate participants or those with elementary education were eligible. Studies were quality assessed using the QUADAS-2 tool. Good or fair quality studies were included in a bivariate random-effects meta-analysis and a hierarchical summary receiver operating characteristic (HSROC) curve constructed. Results Forty-five eligible studies were quality assessed. A significant proportion utilized a case-control design, resulting in spectrum bias. The area under the ROC (AUROC) curve was 0.937 for community/low prevalence studies, 0.881 for clinic based/higher prevalence studies, and 0.869 for illiterate populations. For the Mini-Mental State Examination (MMSE) (and adaptations), the AUROC curve was 0.853. Conclusion Numerous tools for assessment of cognitive impairment in low-literacy settings have been developed, and tools developed for use in high-income countries have also been validated in low-literacy settings. Most tools have been inadequately validated, with only MMSE, cognitive abilities screening instrument (CASI), Eurotest, and Fototest having more than one published good or fair quality study in an illiterate or low-literate setting. At present no screening test can be recommended.
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APA 7th
Paddick, S. M., Gray, W. K., McGuire, J., Richardson, J., Dotchin, C., & Walker, R. W. (2017). Cognitive screening tools for identification of dementia in illiterate and low-educated older adults, a systematic review and meta-analysis. International psychogeriatrics. https://doi.org/10.1017/s1041610216001976
Vancouver
Paddick SM, Gray WK, McGuire J, Richardson J, Dotchin C, Walker RW. Cognitive screening tools for identification of dementia in illiterate and low-educated older adults, a systematic review and meta-analysis. International psychogeriatrics. 2017. doi:10.1017/s1041610216001976. PMID: 28274299.
BibTeX
@article{paddick2017-28274299,
author = {Paddick, S. M. and Gray, W. K. and McGuire, J. and Richardson, J. and Dotchin, C. and Walker, R. W.},
title = {{Cognitive screening tools for identification of dementia in illiterate and low-educated older adults, a systematic review and meta-analysis}},
journal = {International psychogeriatrics},
year = {2017},
doi = {10.1017/s1041610216001976},
pmid = {28274299},
url = {https://doi.org/10.1017/s1041610216001976}
}
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Key findings
- Results Forty-five eligible studies were quality assessed.
- A significant proportion utilized a case-control design, resulting in spectrum bias.
Why it matters
This review of cognitive screening tools found that many validation studies used a case-control design, which can cause spectrum bias. It does not test any treatment, cure or prevention for Alzheimer's disease.
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Study details
- Study designmeta-analysis
- Evidence strengthHigh
How this study scored 57/100
Published in a peer-reviewed journal, and it is a meta-analysis pooling many studies. Scored zero for sample size, effect reported and studied in people because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (International psychogeriatrics) |
| Journal's citation record | 2 / 4 | International Psychogeriatrics: journal h-index 161 (OpenAlex, 2026-10-29) |
| Study design | 12 / 12 | A meta-analysis pooling many studies |
| Strength of evidence | 5 / 5 | Rated “high” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 2 / 5 | 2017 — within 10 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | A review of other studies — randomisation is not credited here |
| Times cited | 4 / 7 | Cited 95 times (OpenAlex, 2026-10-10) |
| Citations per year | 3 / 5 | 8.6 citations a year over 11 year(s) since 2017 |
| Impact for its field and year | 2 / 6 | Cited 1.7× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 1 / 6 | Cited by 2 other studies in this library |
| Still being cited | 2 / 4 | Cited 33 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Richard William Walker: h-index 58 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | Newcastle University: institution h-index 932 (OpenAlex) |
| Multi-centre collaboration | 1 / 3 | OpenAlex lists 3 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 28274299) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 57 / 100 | — |
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Read the original
- DOI: 10.1017/s1041610216001976
- PubMed: 28274299
- Original source →
- Free full text: International Psychogeriatrics →
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
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