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Screening for cognitive impairment: comparing the performance of four instruments in primary care
Holsinger T, Plassman BL, Stechuchak KM, Burke JR, Coffman CJ, Williams JW.. Journal of the American Geriatrics Society, 2012-05-30
Topic: Risk, prevention and care in population studies
Objectives To determine whether brief cognitive screening tests perform as well as a longer screening test in diagnosis of cognitive impairment, no dementia (CIND) or dementia. Design A cross-sectional comparison of cognitive screening tests to an independent criterion standard evaluation using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. Performance of the cognitive screening tests for identifying dementia, and separately for identifying dementia or CIND, was characterized using sensitivity, specificity, likelihood ratios, and diagnostic odds ratios. Setting Three Department of Veterans Affairs primary care clinics. Participants Of 826 independently living veterans aged 65 and older without a prior diagnosis of dementia, 639 participated and 630 were assigned a research diagnosis. Measurements Screening tests included the modified Mini-Mental State Examination (3MS; average time to administer, 17 minutes) and three brief instruments: the Memory Impairment Screen (MIS; 4 minutes), the Mini-Cog (3 minutes), and a novel two-item functional memory screen (MF-2; 1.5 minutes). Results Participants were aged 74.8 on average and were mostly white or black. They were mostly male (92.9%) and had been prescribed a mean of 7.7 medications for chronic conditions. The prevalence of dementia and CIND was 3.3% and 39.2%, respectively. Sensitivity and specificity for dementia were 86% and 79% for the 3MS, 76% and 73% for the Mini-Cog, 43% and 93% for the MIS, and 38% and 87% for the MF-2, respectively. Conclusion In individuals without a prior diagnosis of cognitive impairment, the prevalence of dementia was low, but the prevalence of CIND was high. The 3MS and Mini-Cog had reasonable performance characteristics for detecting dementia, but a definitive diagnosis requires additional evaluation.
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APA 7th
Holsinger, T., Plassman, B. L., Stechuchak, K. M., Burke, JR., Coffman, C. J., & Williams, J. W. (2012). Screening for cognitive impairment: comparing the performance of four instruments in primary care. Journal of the American Geriatrics Society. https://doi.org/10.1111/j.1532-5415.2012.03967.x
Vancouver
Holsinger T, Plassman BL, Stechuchak KM, Burke JR, Coffman CJ, Williams JW. Screening for cognitive impairment: comparing the performance of four instruments in primary care. Journal of the American Geriatrics Society. 2012. doi:10.1111/j.1532-5415.2012.03967.x. PMID: 22646750.
BibTeX
@article{holsinger2012-22646750,
author = {Holsinger, T. and Plassman, B. L. and Stechuchak, K. M. and Burke, JR. and Coffman, C. J. and Williams, J. W.},
title = {{Screening for cognitive impairment: comparing the performance of four instruments in primary care}},
journal = {Journal of the American Geriatrics Society},
year = {2012},
doi = {10.1111/j.1532-5415.2012.03967.x},
pmid = {22646750},
url = {https://doi.org/10.1111/j.1532-5415.2012.03967.x}
}
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Key findings
- Results Participants were aged 74.8 on average and were mostly white or black.
Why it matters
This study compared brief cognitive screening tests with a longer test for identifying dementia or cognitive impairment without dementia in primary care. It is about how well screening tools detect these conditions, not about treating, curing, or preventing Alzheimer's disease.
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Study details
- Study designcross-sectional
- Effect size92.9%; 3.3%; 39.2%
- Evidence strengthLow
How this study scored 48/100
Published in a peer-reviewed journal, and it is a snapshot of people at one point in time. Scored zero for sample size, studied in people and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Journal of the American Geriatrics Society) |
| Journal's citation record | 3 / 4 | Journal of the American Geriatrics Society: journal h-index 344 (OpenAlex, 2026-10-29) |
| Study design | 4 / 12 | A snapshot of people at one point in time |
| 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 | 2012 — within 20 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 | 2 / 3 | Effect reported as a number, without an interval or test |
| 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 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 5 / 7 | Cited 118 times (OpenAlex, 2026-10-10) |
| Citations per year | 2 / 5 | 7.4 citations a year over 16 year(s) since 2012 |
| Impact for its field and year | 3 / 6 | Cited 3.5× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 2 / 6 | Cited by 7 other studies in this library |
| Still being cited | 1 / 4 | Cited 14 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author John W Williams: h-index 77 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | Duke Medical Center: institution h-index 1,255 (OpenAlex) |
| Multi-centre collaboration | 1 / 3 | OpenAlex lists 3 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 22646750) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 48 / 100 | — |
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