Cognitive assessment tools for mild cognitive impairment screening

  • Lei Zhuang
  • Yan Yang
  • Jianqun GaoEmail author


Mild cognitive impairment (MCI) is a clinical condition with a high risk of progression to dementia. Due to lack of effective disease-modifying therapies for advanced dementia, diagnosis and disease intervention at an early stage, particularly at MCI stage, has been widely accepted as a critical strategy in disease management that could potentially affect long-term outcome. However, there is currently no consensus on guidelines for routine screening of MCI, resulting in a considerable number of patients with undiagnosed MCI from community. In addition, the use of different screening guidelines leads to difficulties in comparing different studies. A variety of screening tools have been utilized; however, the sensitivity and specificity vary greatly among these tools. By summarizing the sensitivity, specificity and time efficiency for common MCI screening tools, which are key factors to be taken into consideration when making selections and combinations of screening tools, this review suggests the use of a combination of two self-administered highly sensitive tools, p-AD8 + IQCODE (informant questionnaire on cognitive decline in the elderly individuals) in initial screening, as well as a combination of two highly specific widely covered tools, DemTect + MoCA (Montreal cognitive assessment) or memory and executive screening (MES) + MoCA in secondary screening. In addition, this review also proposes a screening flowchart for MCI, aiming to build a sensitive and time efficient way for recruiting subjects for subsequent investigation and disease differentiation.


Cognitive assessment Mild cognitive impairment Dementia Screening Differential diagnosis 


Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflicts of interest.

Ethical standards

This manuscript does not contain clinical studies or patient data.


  1. 1.
    Cummings J et al (2016) Drug development in Alzheimer's disease: the path to 2025. Alzheimers Res Ther 8:39Google Scholar
  2. 2.
    Kinsella GJ et al (2009) Early intervention for mild cognitive impairment: a randomised controlled trial. J Neurol Neurosurg Psychiatry 80(7):730–736Google Scholar
  3. 3.
    Albert MS et al (2011) The diagnosis of mild cognitive impairment due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement 7(3):270–279Google Scholar
  4. 4.
    Elman JA et al (2018) Underdiagnosis of mild cognitive impairment: a consequence of ignoring practice effects. Alzheimers Dement (Amst) 10:372–381Google Scholar
  5. 5.
    Gauthier S et al (2006) Mild cognitive impairment. Lancet 367(9518):1262–1270Google Scholar
  6. 6.
    Gillis C et al (2019) The incidence of mild cognitive impairment: a systematic review and data synthesis. Alzheimers Dement (Amst) 11:248–256Google Scholar
  7. 7.
    Winblad B et al (2004) Mild cognitive impairment-beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. J Intern Med 256(3):240–246Google Scholar
  8. 8.
    Dubois B et al (2007) Research criteria for the diagnosis of Alzheimer's disease: revising the NINCDS-ADRDA criteria. Lancet Neurol 6(8):734–746Google Scholar
  9. 9.
    Petersen RC et al (2014) Mild cognitive impairment: a concept in evolution. J Intern Med 275(3):214–228Google Scholar
  10. 10.
    Petersen RC (2004) Mild cognitive impairment as a diagnostic entity. J Intern Med 256(3):183–194Google Scholar
  11. 11.
    Busse A et al (2006) Mild cognitive impairment: long-term course of four clinical subtypes. Neurology 67(12):2176–2185Google Scholar
  12. 12.
    Canevelli M et al (2016) Spontaneous reversion of mild cognitive impairment to normal cognition: a systematic review of literature and meta-analysis. J Am Med Dir Assoc 17(10):943–948Google Scholar
  13. 13.
    Koch T, Iliffe S (2010) Rapid appraisal of barriers to the diagnosis and management of patients with dementia in primary care: a systematic review. BMC Fam Pract 11:52Google Scholar
  14. 14.
    Fischer P et al (2007) Conversion from subtypes of mild cognitive impairment to Alzheimer dementia. Neurology 68(4):288–291Google Scholar
  15. 15.
    Wallin A et al (2016) The Gothenburg MCI study: design and distribution of Alzheimer's disease and subcortical vascular disease diagnoses from baseline to 6-year follow-up. J Cereb Blood Flow Metab 36(1):114–131Google Scholar
  16. 16.
    Dubois B et al (2016) Timely diagnosis for Alzheimer's disease: a literature review on benefits and challenges. J Alzheimers Dis 49(3):617–631Google Scholar
  17. 17.
    Li F, Jia XF, Jia J (2012) The informant questionnaire on cognitive decline in the elderly individuals in screening mild cognitive impairment with or without functional impairment. J Geriatr Psychiatry Neurol 25(4):227–232Google Scholar
  18. 18.
    Abd Razak MA et al (2019) Validity of screening tools for dementia and mild cognitive impairment among the elderly in primary health care: a systematic review. Public Health 169:84–92Google Scholar
  19. 19.
    Harrison JK et al (2016) Informant questionnaire on cognitive decline in the elderly (IQCODE) for the early diagnosis of dementia across a variety of healthcare settings. Cochrane Database Syst Rev 11:CD011333Google Scholar
  20. 20.
    Galvin JE et al (2007) Patient's rating of cognitive ability: using the AD8, a brief informant interview, as a self-rating tool to detect dementia. Arch Neurol 64(5):725–730Google Scholar
  21. 21.
    Chen HH et al (2018) The diagnostic accuracy of the Ascertain Dementia 8 questionnaire for detecting cognitive impairment in primary care in the community, clinics and hospitals: a systematic review and meta-analysis. Fam Pract 35(3):239–246Google Scholar
  22. 22.
    Carpenter CR et al (2011) The six-item screener and AD8 for the detection of cognitive impairment in geriatric emergency department patients. Ann Emerg Med 57(6):653–661Google Scholar
  23. 23.
    Chin R et al (2013) Utility of the AD8 as a self-rating tool for cognitive impairment in an Asian population. Am J Alzheimers Dis Other Dementias 28(3):284–288Google Scholar
  24. 24.
    Tierney MC et al (2014) Feasibility and validity of the self-administered computerized assessment of mild cognitive impairment with older primary care patients. Alzheimer Dis Assoc Disord 28(4):311–319Google Scholar
  25. 25.
    Aslam RW et al (2018) A systematic review of the diagnostic accuracy of automated tests for cognitive impairment. Int J Geriatr Psychiatry 33(4):561–575Google Scholar
  26. 26.
    Judge D et al (2019) Physician practice patterns associated with diagnostic evaluation of patients with suspected mild cognitive impairment and Alzheimer's Disease. Int J Alzheimers Dis 2019:4942562Google Scholar
  27. 27.
    Ozer S et al (2016) A systematic review of the diagnostic test accuracy of brief cognitive tests to detect amnestic mild cognitive impairment. Int J Geriatr Psychiatry 31(11):1139–1150Google Scholar
  28. 28.
    Tsoi KKF et al (2017) Recall tests are effective to detect mild cognitive impairment: a systematic review and meta-analysis of 108 diagnostic studies. Am Med Dir Assoc 18(9):807e17–807e29Google Scholar
  29. 29.
    Pinto TCC et al (2019) Is the Montreal cognitive assessment (MoCA) screening superior to the mini-mental state examination (MMSE) in the detection of mild cognitive impairment (MCI) and Alzheimer's disease (AD) in the elderly? Int Psychogeriatr 31(4):491–504Google Scholar
  30. 30.
    Cordell CB et al (2013) Alzheimer's Association recommendations for operationalizing the detection of cognitive impairment during the medicare annual wellness visit in a primary care setting. Alzheimers Dementias 9(2):141–150Google Scholar
  31. 31.
    Folstein MF, Folstein SE, McHugh PR (1975) Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12(3):189–198Google Scholar
  32. 32.
    Sokolowska N et al (2018) Comparison of the effectiveness of the Montreal cognitive assessment 7.2 and the mini-mental state examination in the detection of mild neurocognitive disorder in people over 60 years of age. Preliminary study. Psychiatr Pol 52(5):843–857Google Scholar
  33. 33.
    Saji M et al (2019) Cognitive assessment using the revised Hasegawa's dementia scale to determine the mid-term outcomes following transcatheter aortic valve replacement. J CardiolGoogle Scholar
  34. 34.
    Lischka AR et al (2012) A systematic review of screening tools for predicting the development of dementia. Can J Aging 31(3):295–311Google Scholar
  35. 35.
    Kalbe E et al (2004) DemTect: a new, sensitive cognitive screening test to support the diagnosis of mild cognitive impairment and early dementia. Int J Geriatr Psychiatry 19(2):136–143Google Scholar
  36. 36.
    Welsh K et al (1991) Detection of abnormal memory decline in mild cases of Alzheimer's disease using CERAD neuropsychological measures. Arch Neurol 48(3):278–281Google Scholar
  37. 37.
    Junkkila J et al (2012) Applicability of the CANTAB-PAL computerized memory test in identifying amnestic mild cognitive impairment and Alzheimer's disease. Dementias Geriatr Cogn Disord 34(2):83–89Google Scholar
  38. 38.
    Guo QH et al (2012) Memory and Executive Screening (MES): a brief cognitive test for detecting mild cognitive impairment. BMC Neurol 12:119Google Scholar
  39. 39.
    Delgado Derio C et al (2013) Memory, fluency, and orientation: a 5-min screening test for cognitive decline. Neurologia 28(7):400–407Google Scholar
  40. 40.
    Papageorgiou SG, Economou A, Routsis C (2014) The 5 objects test: a novel, minimal-language, memory screening test. J Neurol 261(2):422–431Google Scholar
  41. 41.
    Wellens NI et al (2013) Convergent validity of the cognitive performance scale of the interRAI acute care and the mini-mental state examination. Am J Geriatr Psychiatry 21(7):636–645Google Scholar
  42. 42.
    Douglas A et al (2012) Use of the cognitive performance test for identifying deficits in hospitalized older adults. Rehabil Res Pract 2012:638480Google Scholar
  43. 43.
    Tarnanas I et al (2013) Ecological validity of virtual reality daily living activities screening for early dementia: longitudinal study. JMIR Serious Games 1(1):e1Google Scholar
  44. 44.
    Zygouris S et al (2015) Can a virtual reality cognitive training application fulfill a dual role? Using the virtual supermarket cognitive training application as a screening tool for mild cognitive impairment. J Alzheimers Dis 44(4):1333–1347Google Scholar
  45. 45.
    Petersen RC et al (2018) Practice guideline update summary: mild cognitive impairment: report of the guideline development, dissemination, and implementation subcommittee of the American Academy of Neurology. Neurology 90(3):126–135Google Scholar
  46. 46.
    Carson N, Leach L, Murphy KJ (2018) A re-examination of Montreal cognitive assessment (MoCA) cutoff scores. Int J Geriatr Psychiatry 33(2):379–388Google Scholar
  47. 47.
    Ehreke L et al (2010) Is the clock drawing test a screening tool for the diagnosis of mild cognitive impairment? A systematic review. Int Psychogeriatr 22(1):56–63Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of NeurologyRenji Hospital Affiliated to Shanghai Jiaotong University School of MedicineShanghaiChina
  2. 2.Department of NursingRenji Hospital Affiliated to Shanghai Jiaotong University School of MedicineShanghaiChina
  3. 3.Brain and Mind Centre, Central Clinical Schoolthe University of SydneySydneyAustralia

Personalised recommendations