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Six-item screener to identify cognitive impairment among potential subjects for clinical research
Callahan CM, Unverzagt FW, Hui SL, Perkins AJ, Hendrie HC.. Medical care, 2002-09-01
Topic: Risk, prevention and care in population studies
Objective To design a brief cognitive screener with acceptable sensitivity and specificity for identifying subjects with cognitive impairment. Design Cohort one is assembled from a community-based survey coupled with a second-stage diagnostic evaluation using formal diagnostic criteria for dementia. Cohort two is assembled from referrals to a specialty clinic for dementing disorders that completed the same diagnostic evaluation. Setting Urban neighborhoods in Indianapolis, Indiana and the Indiana Alzheimer Disease Center. Patients Cohort one consists of 344 community-dwelling black persons identified from a random sample of 2212 black persons aged 65 and older residing in Indianapolis; cohort two consists of 651 subject referrals to the Alzheimer Disease Center. Measurements Formal diagnostic clinical assessments for dementia including scores on the Mini-mental state examination (MMSE), a six-item screener derived from the MMSE, the Blessed Dementia Rating Scale (BDRS), and the Word List Recall. Based on clinical evaluations, subjects were categorized as no cognitive impairment, cognitive impairment-not demented, or demented. Results The mean age of the community-based sample was 74.4 years, 59.4% of the sample were women, and the mean years of education was 10.1. The prevalence of dementia in this sample was 4.3% and the prevalence of cognitive impairment was 24.6%. Using a cut-off of three or more errors, the sensitivity and specificity of the six-item screener for a diagnosis of dementia was 88.7 and 88.0, respectively. In the same sample, the corresponding sensitivity and specificity for the MMSE using a cut-off score of 23 was 95.2 and 86.7. The performance of the two scales was comparable across the two populations studied and using either cognitive impairment or dementia as the gold standard. An increasing number of errors on the six-item screener is highly correlated with poorer scores on longer measures of cognitive impairment. Conclusions The six-item screener is a brief and reliable instrument for identifying subjects with cognitive impairment and its diagnostic properties are comparable to the full MMSE. It can be administered by telephone or face-to-face interview and is easily scored by a simple summation of errors.
Key findings
- Results The mean age of the community-based sample was 74.4 years, 59.4% of the sample were women, and the mean years of education was 10.1.
Why it matters
Researchers built a six-question memory and thinking screen from the longer MMSE and tested it in 344 older Black adults in Indianapolis and 651 people referred to a dementia clinic. Counting three or more errors as a positive screen, it picked up 88.7% of people with dementia, with 88.0% specificity, against 95.2% and 86.7% for the full MMSE. The authors call it "comparable to the full MMSE" and quick to score. It is a screen that flags people for a full assessment; it does not diagnose dementia and offers no treatment or prevention.
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Study details
- Effect size59.4%; 4.3%; 24.6%
- Evidence strengthModerate
How this study scored 56/100
Published in a peer-reviewed journal. Scored zero for study design, 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 (Medical care) |
| Journal's citation record | 3 / 4 | Medical Care: journal h-index 273 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2002 — older than 20 years, still counted |
| 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 | 7 / 7 | Cited 1,506 times (OpenAlex, 2026-10-10) |
| Citations per year | 5 / 5 | 57.9 citations a year over 26 year(s) since 2002 |
| Impact for its field and year | 3 / 6 | Cited 6.1× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 3 / 6 | Cited by 21 other studies in this library |
| Still being cited | 4 / 4 | Cited 267 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Hugh C. Hendrie: h-index 76 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | Indiana University: institution h-index 926 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 4 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 12218768) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 56 / 100 | — |
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Read the original
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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
Callahan, C. M., Unverzagt, F. W., Hui, S. L., Perkins, A. J., & Hendrie, H. C. (2002). Six-item screener to identify cognitive impairment among potential subjects for clinical research. Medical care. https://doi.org/10.1097/00005650-200209000-00007
Vancouver
Callahan CM, Unverzagt FW, Hui SL, Perkins AJ, Hendrie HC. Six-item screener to identify cognitive impairment among potential subjects for clinical research. Medical care. 2002. doi:10.1097/00005650-200209000-00007. PMID: 12218768.
BibTeX
@article{callahan2002-12218768,
author = {Callahan, C. M. and Unverzagt, F. W. and Hui, S. L. and Perkins, A. J. and Hendrie, H. C.},
title = {{Six-item screener to identify cognitive impairment among potential subjects for clinical research}},
journal = {Medical care},
year = {2002},
doi = {10.1097/00005650-200209000-00007},
pmid = {12218768},
url = {https://doi.org/10.1097/00005650-200209000-00007}
}
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