Abstract
Objectives
To compare the diagnostic performance of computerized and paper-and-pencil memory
tests in detection of mild cognitive impairment (MCI) and dementia.
Design
Diagnostic studies comparing computerized or paper-and-pencil memory tests with the
standard diagnostic criterion for MCI or dementia were identified from OVID databases.
The primary outcome was the diagnostic performance of memory tests for detection of
MCI, and detection of dementia was the secondary outcome. Risk of bias and reporting
quality in included studies was assessed.
Setting and Participants
Participants with MCI and dementia in any kind of setting.
Measures
Bivariate random-effects models were used to combine the diagnostic performance of
memory tests and presented with a summary receiver-operating characteristic curve.
Results
A total of 58 studies with 18,450 participants with mean age ranging from 55 to 84 years
were included. For the verbal memory tests on patients with MCI, computerized tests
showed diagnostic accuracy of 0.89 sensitivity (95% confidence interval [CI] 0.69–0.97)
and 0.82 specificity (95% CI 0.70–0.90), whereas paper-and-pencil tests showed diagnostic
accuracy of 0.86 sensitivity (95% CI 0.82–0.90) and 0.82 specificity (95% CI 0.76–0.86).
For the visual memory tests on MCI patients, computerized tests showed diagnostic
accuracy of 0.79 sensitivity (95% CI 0.71–0.84) and 0.80 specificity (95% CI 0.71–0.86),
whereas paper-and-pencil tests showed diagnostic accuracy of 0.80 sensitivity (95%
CI 0.67–0.89) and 0.68 specificity (95% CI 0.51–0.81). The findings were also comparable
to those with dementia.
Conclusions/Implications
Both verbal and visual computerized memory tests showed comparable diagnostic performance
to the paper-and-pencil tests. Computerized cognitive tests show a great potential
to use as an alternative to paper-and-pencil tests. When the records can be digitalized,
long-term monitoring of cognitive function will be feasible for better management
of dementia.
Keywords
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References
- Mild cognitive impairment.N Engl J Med. 2011; 364: 2227-2234
- The global prevalence of dementia: A systematic review and meta-analysis.Alzheimers Dement. 2013; 9: 63-75
- Computerized cognitive training in older adults with mild cognitive impairment or dementia: A systematic review and meta-analysis.Am J Psychiatry. 2017; 174: 329-340
- Cognitive tests to detect dementia. A systematic review and meta-analysis.JAMA Intern Med. 2015; 175: 1450-1458
- Recall tests are effective to detect mild cognitive impairment: A systematic review and meta-analysis of 108 diagnostic studies.J Am Med Dir Assoc. 2017; 18: 807.e17-807.e29
- Status of computerized cognitive testing in aging: A systematic review.Alzheimers Dement. 2008; 4: 428-437
- Assessment of cognition in mild cognitive impairment: A comparative study.Alzheimers Dement. 2011; 7: 338-355
- Computerized cognitive assessment in primary care to identify patients with suspected cognitive impairment.J Alzheimers Dis. 2010; 20: 823-832
- Computerized cognitive testing for older adults: A review.Am J Alzheimers Dis Other Demen. 2015; 30: 13-28
- Computerized Neurocognitive Test (CNT) in mild cognitive impairment and Alzheimer's disease.Dement Neuropsychol. 2014; 8: 112-116
- “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician.J Psychiatr Res. 1975; 12: 189-198
- Evaluation of a computerized test system to screen for mild cognitive impairment.Psychogeriatrics. 2005; 5: 36-41
- The clinical utility of the Hopkins Verbal Learning Test as a screening test for mild dementia.Int J Geriatr Psychiatry. 2000; 15: 317-324
- Rey Complex Figure Test and Recognition Trial.(Professional manual) Psychological Assessment Resource, Odessa, FL1995
- Differential memory test sensitivity for diagnosing amnestic mild cognitive impairment and predicting conversion to Alzheimer's disease.Neuropsychol Dev Cogn B Aging Neuropsychol Cogn. 2009; 16: 357-376
- The Indiana Faces in Places Test: Preliminary findings on a new visuospatial memory test in patients with mild cognitive impairment.Arch Clin Neuropsychol. 2009; 24: 607-618
- Is the WMS-IV Verbal Paired Associates as effective as other memory tasks in discriminating amnestic mild cognitive impairment from normal aging?.Clin Neuropsychol. 2013; 27: 908-923
- Methods to improve the detection of mild cognitive impairment.Proc Natl Acad Sci U S A. 2005; 102: 4919-4924
- Memory function in very early Alzheimer's disease.Neurology. 1994; 44: 867-872
- Is semantic memory consistently impaired early in the course of Alzheimer's disease? Neuroanatomical and diagnostic implications.Neuropsychologia. 1995; 33: 441-459
- Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement.Ann Intern Med. 2009; 151: 264-269
- Cochrane Diagnostic Test Accuracy Working Group. Systematic reviews of diagnostic test accuracy.Ann Intern Med. 2008; 149: 889-897
- Chapter 10: Analysing and presenting results.in: Deeks J.J. Bossuyt P.M. Gatsonis C. Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy Version 1.0. The Cochrane Collaboration, 2010 (Available at:) (Accessed October 15, 2017)
- Mild cognitive impairment: Clinical characterization and outcome.Arch Neurol. 1999; 56: 303-308
- Mild cognitive impairment: Beyond controversies, towards a consensus: Report of the international working group on mild cognitive impairment.J Intern Med. 2004; 256: 240-246
- The clinical dementia rating (CDR): Current version and scoring rules.Neurology. 1993; 43: 2412-2414
- 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. 1984; 34: 939-944
- Diagnostic and Statistical Manual of Mental Disorders.(Revised (DSM-IV-TR))4th ed. American Psychiatric Association, Washington, DC2000
- Diagnostic and Statistical Manual of Mental Disorders.(DSM-V)5th ed. American Psychiatric Association, Washington, DC2013
- The Consortium to Establish a Registry for Alzheimer's Disease (CERAD). Part 1. Clinical and Neuropsychological assessment of Alzheimer's disease.Neurology. 1989; 39: 1159-1165
- Computerized visuo-spatial memory test as a supplementary screening test for dementia.Psychogeriatrics. 2010; 10: 77-82
- QUADAS-2 Group. QUADAS-2: A revised tool for the quality assessment of diagnostic accuracy studies.Ann Intern Med. 2011; 155: 529-536
- The STARD statement for reporting studies of diagnostic accuracy: Explanation and elaboration.Ann Intern Med. 2003; 138: W1-W12
- Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews.J Clin Epidemiol. 2005; 58: 982-990
- The diagnostic odds ratio: A single indicator of test performance.J Clin Epidemiol. 2003; 56: 1129-1135
- A hierarchical regression approach to meta-analysis of diagnostic test accuracy evaluations.Stat Med. 2001; 20: 2865-2884
- Measuring the accuracy of diagnostic systems.Science. 1988; 240: 1285-1293
- Meta-analysis in clinical trials.Control Clin Trials. 1986; 7: 177-188
- Application of summary receiver operating characteristics (sROC) analysis to diagnostic clinical testing.Adv Med Sci. 2007; 52: 76-82
- A comparison of screening tools for the assessment of mild cognitive impairment: preliminary findings.Neurocase. 2012; 18: 336-351
- Comparison between the story recall test and the word-list learning test in Korean patients with mild cognitive impairment and early stage of Alzheimer’s disease.J Clin Exp Neuropsychol. 2012; 34: 396-404
- Screening for cognitive impairment: a triage for outpatients care.Dement Geriatr Cogn Disord. 2005; 20: 278-285
- The Mini-cog: a cognitive ‘vital signs’ measure for dementia screening in multi-lingual elderly.Int J Geriatr Psychiatry. 2000; 15: 1021-1027
- The Mini-cog as a screen for dementia: validation in a population-based sample.J Am Geriatr Soc. 2003; 51: 1451-1454
- Diagnosis of early dementia by the double memory test: encoding specificity improves diagnostic sensitivity and specificity.Neurology. 1997; 48: 989-997
- Screening for dementia with the memory impairment screen.Neurology. 1999; 52: 231-238
- Memory binding test distinguishes amnestic mild cognitive impairment and dementia from cognitively normal elderly.Arch Clin Neuropsychol. 2017; 32: 29-39
- A total score for the CERAD neuropsychological battery.Neurology. 2005; 65: 102-106
- Validation the Chinese version of the verbal learning test for screening Alzheimer’s disease.J Int Neuropsychol Soc. 2010; 16: 244-251
- The Japanese MCI screen for early detection of Alzheimer’s disease and related disorders.Am J Alzheimers Dis Other Demen. 2008; 23: 162-166
- Combining the memory impairment screen and the isaaces set test: a practical tool for screening dementias.J Am Geriatr Soc. 2007; 55: 1426-1430
DeBros GB. Relationships between Tests of Visual Memory in Patients with Mild Cognitive Impairment and Alzheimer’s Disease. (PhD thesis).
- Detection of MCI in the clinic: evaluation of the sensitivity and specificity of a computerized test battery, the hopjins verbal learning test and the MMSE.Age Ageing. 2009; 38: 455-460
- Validation of the seven minute screen neurocognitive battery for the diagnosis of dementia in a Spanish population-based sample.Dement Geriatr Cogn Disord. 2006; 22: 454-464
- The 10-word learning task in the differential diagnosis of early Alzheimer’s disease and elderly depression: a cross-sectional pilot study.Aging Ment Health. 2011; 15: 113-121
- Cued recall and other cognitive tasks to facilitate dementia recognition in primary care.J Am Geriatr Soc. 2012; 60: 130-135
- The clinical utility of the Hopkins verbal learning test as a screening test for mold dementia.Int J Geriatr Psychiatry. 2000; 15: 317-324
- Clinical utility of the Hopkins verbal test-revised for detecting Alzheimer’s disease and mild cognitive impairment in Spanish population.Arch Clin Neuropsychol. 2013; 28: 245-253
- Free and cued selective reminding distinguishes Alzheimer’s disease from vascular dementia.J Am Geriatr Soc. 2008; 56: 944-946
- Neuropsychological strategies for detecting early dementia.J Int Neuropsychol Soc. 2008; 14: 130-142
- Neurocognitive testing supports a broader concept of mild cognitive impairment.Am J Alzheimers Dis Other Demen. 2005; 20: 359-366
- Screening for cognitive impairment: comparing the performance of four instruments in primary care.J Am Geriatr Soc. 2012; 60: 1027-1036
- The validity of psychometric instruments for detection of dementia in the elderly general population.Int J Geriatr Psychiatry. 1998; 13: 368-380
- Development and evaluation of a computerized test battery for Alzheimer’s disease screening in community-based settings.Am J Alzheimers Dis Other Demen. 2009; 24: 129-135
- Applicability of the CANTAB-PAL computerized memory test in identifying amnestic mild cognitive impairment and Alzheimer’s disease.Dement Geriatr Cogn Disord. 2012; 34: 83-89
- Utility of a computerized cognitive screen in MCI and depression in an older population.Aust J Rehabil Counsell. 2010; 16: 14-26
- Screening for Alzheimer’s disease: the memory impairment screen versus the conventional three-word memory test.J Am Geriatr Soc. 2002; 50: 1086-1091
- Detecting dementia with the Hopkins verbal learning test and the mini-mental state examination.Arch Clin Neuropsychol. 2004; 19: 89-104
- Utility of a modified mini-mental state examination with extended delayed recall in screening for mild cognitive impairment and dementia among community dwelling elders.Int J Geriatr Psychiatry. 2000; 15: 434-440
- The utility of a brief memory screen in the diagnosis of mold memory impairment in the elderly preliminary study.Am J Geriatr Psychiatry. 2009; 28: 437-440
- Computerized visuo-spatial memory teset as a supplementary screening test for dementia.Psychogeriatrics. 2010; 10: 77-82
- Clinical utility of the cogstate brief battery in identifying cognitive impairment in mild cognitive impairment and Alzheimer’s disease.BMC Pharmacol Toxicol. 2013; 1: 30
- Comparative diagnostic accuracy of the ACE-III, MIS, MMSE, MoCA, and RUDAS for screening of Alzheimer Disease.Dement Geriatr Cogn Disord. 2017; 43: 237-246
- Screening mild cognitive impairment by delayed story recall and instrumental activities of daily living.Int J Geriatr Psychiatry. 2015; 30: 888-889
- CERAD neuropsychological battery total score in multinational mild cognitive impairment and control populations: the AddNeuroMed study.J Alzheimers Dis. 2010; 22: 1089-1097
Papadpoulou PA. Assessment of MoCA, Rey, Trails A tests for the characterization of MCI in PD screening using covariate information (Master’s thesis).
- Comparison of the memory performance index with standard neuropsychological measures of cognition.Am J Alzheimers Dis Other Demen. 2011; 26: 235-239
- Sensitivity and specificity of neuropsychological tests for dementia and mild cognitive impairment in a sample of residential elderly in South Africa.S Afr J Psych. 2014; 20: 153-159
- Validation of the Argentine version of the memory Binging test (MBT) for early detection of mild cognitive impairment.Dement Neuropsychol. 2016; 10: 217-226
- How can we best screen for cognitive impairment in Malaysia? A pilot of the IDEA cognitive screen and picture-based memory impairment scale and comparison of criterion validity with the mini mental state examination.Clin Gerontol. 2017; 40: 249-257
- Enhanced cued recall has a high utility as a screening test in the diagnosis of Alzheimer’s disease and mild cognitive impairment in Turkish people.Arch Clin Neuropsychol. 2006; 21: 745-751
- The Chinese version of story recall: a useful screening tool for mild cognitive impairment and Alzheimer’s disease in the elderly.BMC Psychiatry. 2014; 14: 71
- CERAD-neuropsychological battery in screening mild Alzheimer’s disease.Acta Neurol Scand. 2012; 125: 16-23
- Free and cued selective reminding test – accuracy for the differential diagnosis of alzheimer’s and neurodegenerative diseases: a large-scale biomarker-characterized monocenter cohort study (ClinAD).Alzheimers Dement. 2017; 2013: 913-923
- The scale of delayed story recall: A brief screening tool for amnestic mild cognitive impairment in Chinese elderly.Alzheimers Dement. 2012; 8: P361
- Detecting cognitive impairment in primary care: performance assessment of three screening instruments.J Alzheimers Dis. 2007; 11: 323-335
- Neuropsychological markers of mild cognitive impairment: A clinic based study from urban India.Ann Indian Acad Neurol. 2015; 18: 177
- Computerized adaptation of The Placing Test for early detection of both mild cognitive impairment and Alzheimer’s disease.J Clin Exp Neuropsychol. 2013; 35: 846-856
- Picture-based memory impairment screen for dementia.J Am Geriatr Soc. 2012; 60: 2116-2120
- Use of a modified spatial-context memory test to detect amnestic mild cognitive impairment.PLoS One. 2013; 8: e57030
- The CERAD neuropsychological assessment battery total score detects and predicts Alzheimer disease dementia with high diagnostic accuracy.Am J Geriatr Psychiatry. 2014; 22: 1017-1028
- Development of a Rapid Screening Tool for Mild Cognitive Impairment: Validation of a Computer-Based Short-Term Memory Test.Fu-Jen J Med. 2017; 15: 1-10
- Short-term delayed recall of auditory verbal learning test is equivalent to long-term delayed recall for identifying amnestic mild cognitive impairment.PLoS One. 2012; 7: e51157
- Utility of a computerized cognitive screen in MCI and depression in an older population.Aust J Rehabil Counsell. 2010; 16: 14-26
- Computerized Cognitive Screen (CoCoSc): A self-administered computerized test for screening for cognitive impairment in community social centers.J Alzheimers Dis. 2017; 59: 1299-1306
Article info
Publication history
Published online: June 16, 2018
Footnotes
The authors declare no conflicts of interest.
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© 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
