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Six-item cognitive impairment test (6CIT): pragmatic diagnostic accuracy study for dementia and MCI

Published online by Cambridge University Press:  29 January 2015

K. Abdel-Aziz  and
A. J. Larner
K. Abdel-Aziz
Affiliation:
Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Liverpool, UK
A. J. Larner*
Affiliation:
Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Liverpool, UK
*
Correspondence should be addressed to: A. J. Larner, Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Lower Lane, Fazakerley, Liverpool, L9 7LJ, UK. Phone: (44) 151 5298119. Email: a.larner@thewaltoncentre.nhs.uk.
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Abstract

Background:

The six-item cognitive impairment test (6CIT) is a brief cognitive screening instrument (CSI) recommended for use in primary care settings. There are very few studies of 6CIT performance in secondary care settings.

Methods:

We undertook a pragmatic diagnostic accuracy study of 6CIT in consecutive patients referred over the course of one year to a neurology-led cognitive function clinic, and compared its performance for the diagnosis of dementia and mild cognitive impairment (MCI) to that of the simultaneously administered Mini-Mental State Examination (MMSE).

Results:

In a cohort of 245 patients with dementia prevalence around 20%, 6CIT proved quick and easy to use and acceptable to patients. It had good sensitivity (0.88) and specificity (0.78) for dementia diagnosis; it was more sensitive than MMSE (0.59) but less specific (0.85). For MCI diagnosis, 6CIT was again more sensitive (0.66) than MMSE (0.51) but less specific (0.70 vs. 0.75). Weighted comparisons showed net benefit for 6CIT compared to MMSE for both dementia and MCI diagnosis. 6CIT effect sizes (Cohen's d) were large for dementia diagnosis and moderate for MCI diagnosis.

Conclusions:

6CIT is an acceptable and accurate test for the assessment of cognitive problems, its performance being more sensitive than the MMSE. 6CIT use should be considered as a viable alternative to MMSE in the secondary care setting.

Keywords

6CITdementiadiagnosiseffect sizeMMSEsensitivity and specificityweighted comparison
Type
Research Article
Information
International Psychogeriatrics , Volume 27 , Issue 6 , June 2015 , pp. 991 - 997
Copyright
Copyright © International Psychogeriatric Association 2015 

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References

Brodaty, H., Low, L. F., Gibson, L. and Burns, K. (2006). What is the best dementia screening instrument for general practitioners to use? American Journal of Geriatric Psychiatry, 14, 391–400.Google Scholar
Brooke, P. and Bullock, R. (1999). Validation of a 6 item cognitive impairment test with a view to primary care usage. International Journal of Geriatric Psychiatry, 14, 936–940.Google Scholar
Cagliarini, A. M., Price, H. L., Livemore, S. T. and Larner, A. J. (2013). Will use of the six-item cognitive impairment test help to close the dementia diagnosis gap? Aging Health, 9, 563–566. doi: 10.2217/AHE.13.55.Google Scholar
Carnero-Pardo, C. (2014). Should the Mini-Mental State Examination be retired? Neurologia, 29, 473–481. doi: 10.1016/j.nrl.2013.07.003.CrossRefGoogle ScholarPubMed
Cohen, J. (1960). A coefficient of agreement for nominal scales. Educational and Psychological Measurement, 20, 37–46.Google Scholar
Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences, 2nd edn. Hillsdale, New Jersey: Lawrence Erlbaum.Google Scholar
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.Google Scholar
Ghadiri-Sani, M. and Larner, A. J. (2014). Cognitive screening instrument use in primary care: Is it changing? Clinical Practice, 11, 425–429. doi:10.2217/cpr.14.37.Google Scholar
Hessler, J. et al. (2014). Suitability of the 6CIT as a screening test for dementia in primary care patients. Aging & Mental Health, 18, 515–520. doi: 10.1080/13607863.2013.856864.Google Scholar
Jefferies, K. and Gale, T. M. (2013). 6-CIT: six-item cognitive impairment test. In Larner, A. J. (ed.), Cognitive Screening Instruments. A Practical Approach (pp. 209–218). London: Springer. doi: 10.1007/978-1-4471-2452-8_11.CrossRefGoogle Scholar
Katzman, R., Brown, T., Fuld, P., Peck, A., Schechter, R. and Schimmel, H. et al. (1983). Validation of a short orientation-memory-concentration test of cognitive impairment. American Journal of Psychiatry, 40, 734–739.Google Scholar
Landis, J. R. and Koch, G. G. (1977). The measurement of observer agreement for categorical data. Biometrics, 33, 159–174.Google Scholar
Larner, A. J. (2013). Comparing diagnostic accuracy of cognitive screening instruments: a weighted comparison approach. Dementia and Geriatric Cognitive Disorders Extra, 3, 60–65. doi: 10.1159/000348623.Google Scholar
Larner, A. J. (2014a). Dementia in clinical practice: a neurological perspective. Pragmatic Studies in the Cognitive Function Clinic (2nd edn.), London: Springer.Google Scholar
Larner, A. J. (2014b). Effect size (Cohen's d) of cognitive screening instruments examined in pragmatic diagnostic accuracy studies. Dementia and Geriatric Cognitive Disorders Extra, 4, 236–241. doi: 10.1159/000363735.CrossRefGoogle Scholar
Larner, A. J. (2014c). Impact of the national dementia strategy in a neurology-led memory clinic: 5-year data. Clinical Medicine, 14, 216. doi: 10.7861/clinmedicine.14-2-216.CrossRefGoogle Scholar
Larner, A. J. (2015). Optimizing the cutoffs of cognitive screening instruments in pragmatic diagnostic accuracy studies: maximising accuracy or Youden index? Dementia and Geriatric Cognitive Disorders, 39, 167–175.CrossRefGoogle Scholar
Larner, A. J. and Hancock, P. (2014). ACE-R or MMSE? A weighted comparison. International Journal of Geriatric Psychiatry, 29, 767–768. doi: 10.1002/gps.4116.CrossRefGoogle ScholarPubMed
Mallett, S., Halligan, S., Thompson, M., Collins, G. S. and Altman, D. G. (2012). Interpreting diagnostic accuracy studies for patient care. BMJ, 344: e3999. doi: 10.1136/bmj.e3999.Google Scholar
Mitchell, A. J. and Malladi, S. (2010). Screening and case-finding tools for the detection of dementia. Part I: evidence-based meta-analysis of multidomain tests. American Journal of Geriatric Psychiatry, 18, 759–782.Google Scholar
Moons, K. G. M. et al. (1997). Application of treatment thresholds to diagnostic-test evaluation: an alternative to the comparison of areas under receiver operating characteristic curves. Medical Decision Making, 17, 447–454.Google Scholar
Noel-Storr, A. H. et al. (2014). Reporting standards for studies of diagnostic test accuracy in dementia: the STARDdem Initiative. Neurology, 83, 364–373. doi: 10.1212/WNL.0000000000000621.Google Scholar
Petersen, R. C., Smith, G. E., Waring, S. C., Ivnik, R. J., Tangalos, E. G. and Kokmen, E et al. (1999). Mild cognitive impairment: clinical characterization and outcome. Archives of Neurology, 56, 303–308.Google Scholar
Rawle, M. J. and Larner, A. J. (2013). NARP syndrome: a 20-year follow-up. Case Reports in Neurology, 5, 204–207. doi: 10.1159/000357518.CrossRefGoogle ScholarPubMed
Tuijl, J. P., Scholte, E. M., de Craen, A. J. M. and van der Mast, R. C. (2012). Screening for cognitive impairment in older general hospital patients: comparison of the six-item cognitive impairment test with the Mini-Mental State Examination. International Journal of Geriatric Psychiatry, 27, 755–762. doi: 10.1002/gps.2776.Google Scholar
Upadhyaya, A. K., Rajagopal, M. and Gale, T. M. (2010). 6 item cognitive impairment test (6-CIT) as a screening test for dementia: comparison with Mini-Mental State Examination (MMSE). Current Aging Science, 3, 138–142.Google Scholar
Woodford, H. J. and George, J. (2007). Cognitive assessment in the elderly: a review of clinical methods. QJM, 100, 469–484.Google Scholar