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Cognitive Tests to Detect Dementia: A Systematic Review and Meta-analysis
Tsoi KK, Chan JY, Hirai HW, Wong SY, Kwok TC.. JAMA internal medicine, 2015-09-01
Topic: Risk, prevention and care in population studies
Importance Dementia is a global public health problem. The Mini-Mental State Examination (MMSE) is a proprietary instrument for detecting dementia, but many other tests are also available. Objective To evaluate the diagnostic performance of all cognitive tests for the detection of dementia. Data sources Literature searches were performed on the list of dementia screening tests in MEDLINE, EMBASE, and PsychoINFO from the earliest available dates stated in the individual databases until September 1, 2014. Because Google Scholar searches literature with a combined ranking algorithm on citation counts and keywords in each article, our literature search was extended to Google Scholar with individual test names and dementia screening as a supplementary search. Study selection Studies were eligible if participants were interviewed face to face with respective screening tests, and findings were compared with criterion standard diagnostic criteria for dementia. Bivariate random-effects models were used, and the area under the summary receiver-operating characteristic curve was used to present the overall performance. Main outcomes and measures Sensitivity, specificity, and positive and negative likelihood ratios were the main outcomes. Results Eleven screening tests were identified among 149 studies with more than 49,000 participants. Most studies used the MMSE (n = 102) and included 10,263 patients with dementia. The combined sensitivity and specificity for detection of dementia were 0.81 (95% CI, 0.78-0.84) and 0.89 (95% CI, 0.87-0.91), respectively. Among the other 10 tests, the Mini-Cog test and Addenbrooke's Cognitive Examination-Revised (ACE-R) had the best diagnostic performances, which were comparable to that of the MMSE (Mini-Cog, 0.91 sensitivity and 0.86 specificity; ACE-R, 0.92 sensitivity and 0.89 specificity). Subgroup analysis revealed that only the Montreal Cognitive Assessment had comparable performance to the MMSE on detection of mild cognitive impairment with 0.89 sensitivity and 0.75 specificity. Conclusions and relevance Besides the MMSE, there are many other tests with comparable diagnostic performance for detecting dementia. The Mini-Cog test and the ACE-R are the best alternative screening tests for dementia, and the Montreal Cognitive Assessment is the best alternative for mild cognitive impairment.
Key findings
- Study selection Studies were eligible if participants were interviewed face to face with respective screening tests, and findings were compared with criterion standard diagnostic criteria for dementia.
- Bivariate random-effects models were used, and the area under the summary receiver-operating characteristic curve was used to present the overall performance.
- Results Eleven screening tests were identified among 149 studies with more than 49,000 participants.
- Subgroup analysis revealed that only the Montreal Cognitive Assessment had comparable performance to the MMSE on detection of mild cognitive impairment with 0.89 sensitivity and 0.75 specificity.
Why it matters
This review compared 11 cognitive screening tests across 149 studies with more than 49,000 participants for detecting dementia. It concerns diagnosis only and provides no information on treating, curing or preventing Alzheimer's disease.
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Study details
- Participants102
- Evidence strengthLow
How this study scored 70/100
Published in a leading specialty journal, and it is a meta-analysis pooling many studies. Scored zero for effect reported because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 9 / 10 | Tier 2 — leading specialty journal (JAMA internal medicine) |
| Journal's citation record | 3 / 4 | JAMA Internal Medicine: journal h-index 258 (OpenAlex, 2026-10-29) |
| Study design | 12 / 12 | A meta-analysis pooling many studies (from PubMed type “Meta-Analysis”) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2015 — within 20 year(s) of the newest study here |
| Sample size | 2 / 4 | 102 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | A review of other studies — randomisation is not credited here |
| Times cited | 6 / 7 | Cited 891 times (OpenAlex, 2026-10-10) |
| Citations per year | 5 / 5 | 68.5 citations a year over 13 year(s) since 2015 |
| Impact for its field and year | 5 / 6 | Cited 29.8× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 3 / 6 | Cited by 20 other studies in this library |
| Still being cited | 4 / 4 | Cited 288 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Timothy C. Y. Kwok: h-index 78 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | Chinese University of Hong Kong: institution h-index 1,100 (OpenAlex) |
| Multi-centre collaboration | 0 / 3 | OpenAlex lists 1 institution(s) in 1 country — scores zero (affiliation lists can be incomplete) |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 26052687) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 70 / 100 | — |
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Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Tsoi, K. K., Chan, J. Y., Hirai, H. W., Wong, S. Y., & Kwok, T. C. (2015). Cognitive Tests to Detect Dementia: A Systematic Review and Meta-analysis. JAMA internal medicine. https://doi.org/10.1001/jamainternmed.2015.2152
Vancouver
Tsoi KK, Chan JY, Hirai HW, Wong SY, Kwok TC. Cognitive Tests to Detect Dementia: A Systematic Review and Meta-analysis. JAMA internal medicine. 2015. doi:10.1001/jamainternmed.2015.2152. PMID: 26052687.
BibTeX
@article{tsoi2015-26052687,
author = {Tsoi, K. K. and Chan, J. Y. and Hirai, H. W. and Wong, S. Y. and Kwok, T. C.},
title = {{Cognitive Tests to Detect Dementia: A Systematic Review and Meta-analysis}},
journal = {JAMA internal medicine},
year = {2015},
doi = {10.1001/jamainternmed.2015.2152},
pmid = {26052687},
url = {https://doi.org/10.1001/jamainternmed.2015.2152}
}
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