Mini‐Cog for the detection of dementia within a primary care setting

Background Alzheimer's disease and other forms of dementia are becoming increasingly common with the aging of most populations. The majority of individuals with dementia will first present for care and assessment in primary care settings. There is a need for brief dementia screening instruments that can accurately detect dementia in primary care settings. The Mini‐Cog is a brief, cognitive screening test that is frequently used to evaluate cognition in older adults in various settings. Objectives To determine the accuracy of the Mini‐Cog for detecting dementia in a primary care setting. Search methods We searched the Cochrane Dementia and Cognitive Improvement Register of Diagnostic Test Accuracy Studies, MEDLINE, Embase and four other databases, initially to September 2012. Since then, four updates to the search were performed using the same search methods, and the most recent was January 2017. We used citation tracking (using the databases' ‘related articles’ feature, where available) as an additional search method and contacted authors of eligible studies for unpublished data. Selection criteria We only included studies that evaluated the Mini‐Cog as an index test for the diagnosis of Alzheimer's disease dementia or related forms of dementia when compared to a reference standard using validated criteria for dementia. We only included studies that were conducted in primary care populations. Data collection and analysis We extracted and described information on the characteristics of the study participants and study setting. Using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS‐2) criteria we evaluated the quality of studies, and we assessed risk of bias and applicability of each study for each domain in QUADAS‐2. Two review authors independently extracted information on the true positives, true negatives, false positives, and false negatives and entered the data into Review Manager 5 (RevMan 5). We then used RevMan 5 to determine the sensitivity, specificity, and 95% confidence intervals. We summarized the sensitivity and specificity of the Mini‐Cog in the individual studies in forest plots and also plotted them in a receiver operating characteristic plot. We also created a 'Risk of bias' and applicability concerns graph to summarize information related to the quality of included studies. Main results There were a total of four studies that met our inclusion criteria, including a total of 1517 total participants. The sensitivity of the Mini