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The Mini-Cog versus the Mini-Mental State Examination and the Clock Drawing Test in daily clinical practice: screening value in a German Memory Clinic

Published online by Cambridge University Press:  15 December 2011

Monika Milian ,
Anna-Maria Leiherr ,
Guido Straten ,
Stephan Müller ,
Thomas Leyhe  and
Gerhard W. Eschweiler
Monika Milian*
Affiliation:
Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany Department of Neurosurgery, University of Tübingen, Tübingen, Germany
Anna-Maria Leiherr
Affiliation:
Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
Guido Straten
Affiliation:
Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
Stephan Müller
Affiliation:
Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
Thomas Leyhe
Affiliation:
Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany Geriatric Center at the University Hospital of Tübingen, Tübingen, Germany
Gerhard W. Eschweiler
Affiliation:
Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany Geriatric Center at the University Hospital of Tübingen, Tübingen, Germany
*
Correspondence should be addressed to: Dr. Monika Milian, Department of Neurosurgery, University of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany. Phone: +49-(0)7071-29 81993; Fax: +49-(0)7071-29 4438. Email: monika.milian@med.uni-tuebingen.de.
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Abstract

Background: The aim of this study was to compare the screening value of the Mini-Cog, Clock Drawing Test (CDT), Mini-Mental State Examination (MMSE) and the algorithm MMSE and/or CDT to separate elderly people with dementia from healthy depending on test time, type and severity of dementia, and demographic variables in a German Memory Clinic.

Methods: Data from a heterogeneous patient sample and healthy participants (n = 502) were retrospectively analyzed. Of the 438 patients with dementia, 49.1% of the dementia diagnoses were Alzheimer's dementia and 50.9% were non-Alzheimer's dementia. Sixty-four participants were classified as cognitively unimpaired. The CDT and an extraction of the 3-item recall of the MMSE were used to constitute the Mini-Cog algorithm.

Results: Overall, the Mini-Cog showed significantly higher discriminatory power (86.8%) than the MMSE (72.6% at a cut-off ≤ 24 and 79.2% at ≤ 25, respectively) and CDT (78.1%) (each p < 0.01) and did not perform worse than the algorithm MMSE and/or CDT (each p > 0.05). The specificity of the Mini-Cog (100.0%) was similar to that of the MMSE (100.0% for both cut-offs) and CDT (96.9%) (p = 0.154). For all age and educational groups the Mini-Cog outmatched the CDT and MMSE, and was less affected by education than MMSE and less susceptible for the dementia stage than the CDT.

Conclusion: The Mini-Cog proved to have superior discriminatory power than either CDT or MMSE and is demonstrated to be a valid “short” screening instrument taking 3 to 4 minutes to administer in the geriatric setting.

Keywords

dementiaAlzheimer's diseasesensitivityspecificityscreening tools

Information

Type
Research Article
Information
International Psychogeriatrics , Volume 24 , Issue 5 , May 2012 , pp. 766 - 774
Copyright
Copyright © International Psychogeriatric Association 2011

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References

Ainslie, N. K. and Murden, R. A. (1993). Effect of education on the clock-drawing dementia screen in non-demented elderly persons. Journal of the American Geriatrics Society, 41, 249–252.CrossRefGoogle ScholarPubMed
American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn (DSM-IV). Washington, DC: American Psychiatric Association.Google Scholar
Borson, S. et al. (1999). The Clock Drawing Test: utility for dementia detection in multiethnic elders. Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 54, M534–M540.CrossRefGoogle ScholarPubMed
Borson, S., Scanlan, J., Brush, M., Vitaliano, P. and Dokmak, A. (2000). The Mini-Cog: a cognitive ‘vital signs’ measure for dementia screening in multi-lingual elderly. International Journal of Geriatric Psychiatry, 15, 1021–1027.3.0.CO;2-6>CrossRefGoogle ScholarPubMed
Borson, S., Scanlan, J. M., Chen, P. and Ganguli, M. (2003). The Mini-Cog as a screen for dementia: validation in a population-based sample. Journal of the American Geriatrics Society, 51, 1451–1454.CrossRefGoogle Scholar
Borson, S., Scanlan, J. M., Watanabe, J., Tu, S. P. and Lessig, M. (2005). Simplifying detection of cognitive impairment: comparison of the Mini-Cog and Mini-Mental State Examination in a multiethnic sample. Journal of the American Geriatrics Society, 53, 871–874.CrossRefGoogle Scholar
Braekhus, A., Laake, K. and Engedal, K. (1992). The Mini-Mental State Examination: identifying the most efficient variables for detecting cognitive impairment in the elderly. Journal of the American Geriatrics Society, 40, 1139–1145.CrossRefGoogle ScholarPubMed
Brodaty, H. and Moore, C. M. (1997). The Clock Drawing Test for dementia of the Alzheimer's type: a comparison of three scoring methods in a memory disorders clinic. International Journal of Geriatric Psychiatry, 12, 619–627.3.0.CO;2-H>CrossRefGoogle Scholar
Brodaty, H. et al. (2002). The GPCOG: a new screening test for dementia designed for general practice. Journal of the American Geriatrics Society, 50, 530–534.CrossRefGoogle ScholarPubMed
Buschke, H. et al. (1999). Screening for dementia with the memory impairment screen. Neurology, 52, 231–238.CrossRefGoogle ScholarPubMed
Dougherty, J. H. et al. (2010). The computerized self test (CST): an interactive, internet accessible cognitive screening test for dementia. Journal of Alzheimer's Disease, 20, 185–195.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state:” a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle ScholarPubMed
Freidl, W., Schmidt, R., Stronegger, W. J., Irmler, A., Reinhart, B. and Koch, M. (1996). Mini-Mental State Examination: influence of sociodemographic, environmental and behavioral factors and vascular risk factors. Journal of Clinical Epidemiology, 49, 73–78.CrossRefGoogle ScholarPubMed
Froehlich, T. E., Robison, J. T. and Inouye, S. K. (1998). Screening for dementia in the outpatient setting: the time and change test. Journal of the American Geriatrics Society, 46, 1506–1511.CrossRefGoogle ScholarPubMed
Huppert, F. A., Brayne, C., Gill, C., Paykel, E. S. and Beardsall, L. (1995). CAMCOG – a concise neuropsychological test to assist dementia diagnosis: socio-demographic determinants in an elderly population sample. British Journal of Clinical Psychology, 34, 529–541.CrossRefGoogle Scholar
Jorm, A. F., Scott, R., Henderson, A. S. and Kay, D. W. (1988). Educational level differences on the Mini-Mental State: the role of test bias. Psychological Medicine, 18, 727–731.CrossRefGoogle ScholarPubMed
Juby, A. (1999). Correlation between the Folstein Mini-Mental State Examination and three methods of clock drawing scoring. Journal of Geriatric Psychiatry and Neurology, 12, 87–91.CrossRefGoogle ScholarPubMed
Katzman, R., Brown, T., Fuld, P., Peck, A., Schechter, R. and Schimmel, H. (1983). Validation of a short Orientation-Memory-Concentration Test of cognitive impairment. American Journal of Psychiatry, 140, 734–739.Google Scholar
Kitabayashi, Y., Ueda, H., Narumoto, J., Nakamura, K., Kita, H. and Fukui, K. (2001). Qualitative analyses of clock drawings in Alzheimer's disease and vascular dementia. Psychiatry and Clinical Neurosciences, 55, 485–491.CrossRefGoogle ScholarPubMed
Leopold, N. A. and Borson, A. J. (1997). An alphabetical ‘WORLD.’ A new version of an old test. Neurology, 49, 1521–1524.CrossRefGoogle ScholarPubMed
Leyhe, T., Milian, M., Muller, S., Eschweiler, G. W. and Saur, R. (2009). The minute hand phenomenon in the Clock Test of patients with early Alzheimer disease. Journal of Geriatric Psychiatry and Neurology, 22, 119–129.CrossRefGoogle ScholarPubMed
Lieberman, D., Galinsky, D., Fried, V., Grinshpun, Y., Mytlis, N. and Tylis, R. (1999). Factors affecting the results of the clock drawing test in elderly patients hospitalized for physical rehabilitation. International Journal of Geriatric Psychiatry, 14, 325–330.3.0.CO;2-Q>CrossRefGoogle ScholarPubMed
Liu, H. C. et al. (1994). Performance on a dementia screening test in relation to demographic variables: study of 5297 community residents in Taiwan. Archives of Neurology, 51, 910–915.CrossRefGoogle ScholarPubMed
Lorentz, W. J., Scanlan, J. M. and Borson, S. (2002). Brief screening tests for dementia. Canadian Journal of Psychiatry, 47, 723–733.CrossRefGoogle ScholarPubMed
Magaziner, J., Bassett, S. S. and Hebel, J. R. (1987). Predicting performance on the Mini-Mental State Examination: use of age- and education-specific equations. Journal of the American Geriatrics Society, 35, 996–1000.CrossRefGoogle ScholarPubMed
Manos, P. J. and Wu, R. (1994). The ten point clock test: a quick screen and grading method for cognitive impairment in medical and surgical patients. International Journal of Psychiatry in Medicine, 24, 229–244.CrossRefGoogle ScholarPubMed
McCarten, J. R., Anderson, P., Kuskowski, M. A., McPherson, S. E. and Borson, S. (2011). Screening for cognitive impairment in an elderly veteran population: acceptability and results using different versions of the Mini-Cog. Journal of the American Geriatrics Society, 59, 309–313.CrossRefGoogle Scholar
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D. and Stadlan, E. M. (1984). Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology, 34, 939–944.CrossRefGoogle ScholarPubMed
Mendez, M. F., Ala, T. and Underwood, K. L. (1992). Development of scoring criteria for the clock drawing task in Alzheimer's disease. Journal of the American Geriatrics Society, 40, 1095–1099.CrossRefGoogle ScholarPubMed
Morris, J. C. et al. (1989). The consortium to establish a registry for Alzheimer's disease (CERAD). Part I. Clinical and neuropsychological assessment of Alzheimer's disease. Neurology, 39, 1159–1165.Google Scholar
Mungas, D., Marshall, S. C., Weldon, M., Haan, M. and Reed, B. R. (1996). Age and education correction of Mini-Mental State Examination for English and Spanish-speaking elderly. Neurology, 46, 700–706.CrossRefGoogle ScholarPubMed
Scanlan, J. and Borson, S. (2001). The Mini-Cog: receiver operating characteristics with expert and naive raters. International Journal of Geriatric Psychiatry, 16, 216–222.3.0.CO;2-B>CrossRefGoogle ScholarPubMed
Scanlan, J. M., Brush, M., Quijano, C. and Borson, S. (2002). Comparing clock tests for dementia screening: naive judgments vs formal systems – what is optimal? International Journal of Geriatric Psychiatry, 17, 14–21.CrossRefGoogle ScholarPubMed
Schramm, U., Berger, G., Muller, R., Kratzsch, T., Peters, J. and Frolich, L. (2002). Psychometric properties of Clock Drawing Test and MMSE or Short Performance Test (SKT) in dementia screening in a memory clinic population. International Journal of Geriatric Psychiatry, 17, 254–260.CrossRefGoogle ScholarPubMed
Shulman, K. I. (2000). Clock-drawing: is it the ideal cognitive screening test? International Journal of Geriatric Psychiatry, 15, 548–561.3.0.CO;2-U>CrossRefGoogle ScholarPubMed
Shulman, K. I. and Gold, D. P. (1993). Clock-drawing and dementia in the community: a longitudinal study. International Journal of Geriatric Psychiatry, 8, 487–496.CrossRefGoogle Scholar
Shulman, K. I., Shedletsky, R. and Silver, I. L. (1986). The challenge of time: clock drawing and cognitive function in the elderly. International Journal of Geriatric Psychiatry, 1, 135–140.CrossRefGoogle Scholar
Stuss, D. T., Meiran, N., Guzman, D. A., Lafleche, G. and Willmer, J. (1996). Do long tests yield a more accurate diagnosis of dementia than short tests? A comparison of 5 neuropsychological tests. Archives of Neurology, 53, 1033–1039.CrossRefGoogle Scholar
Sunderland, T. et al. (1989). Clock drawing in Alzheimer's disease: a novel measure of dementia severity. Journal of the American Geriatrics Society, 37, 725–729.CrossRefGoogle ScholarPubMed
Teng, E. L. et al. (1994). The Cognitive Abilities Screening Instrument (CASI): a practical test for cross-cultural epidemiological studies of dementia. International Psychogeriatrics, 6, 45–58, discussion 62.CrossRefGoogle Scholar
Tangalos, E. G. et al. (1996). The Mini-Mental State Examination in general medical practice: clinical utility and acceptance. Mayo Clinic Proceedings, 71, 829–837.CrossRefGoogle ScholarPubMed
Uhlmann, R. F. and Larson, E. B. (1991). Effect of education on the Mini-Mental State Examination as a screening test for dementia. Journal of the American Geriatrics Society, 39, 876–880.CrossRefGoogle ScholarPubMed
Wind, A. W., Schellevis, F. G., van Staveren, G., Scholten, R. P., Jonker, C. and van Eijk, J. T. (1997). Limitations of the Mini-Mental State Examination in diagnosing dementia in general practice. International Journal of Geriatric Psychiatry, 12, 101–108.3.0.CO;2-R>CrossRefGoogle ScholarPubMed
Wolf-Klein, G. P., Silverstone, F. A., Levy, A. P. and Brod, M. S. (1989). Screening for Alzheimer's disease by clock drawing. Journal of the American Geriatrics Society, 37, 730–734.CrossRefGoogle ScholarPubMed
World Health Organization (1992). Mental and behavioural disorders (including disorders of psychological development). International Classification of Diseases, 10th Revision, Chapter 5 (F):. Geneva, Switzerland: World Health Organization.Google Scholar