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The Value of Collateral History in Screening for Mild Cognitive Impairment in Elderly with Diabetes Mellitus in Outpatient Clinics
The increase in life expectancy can influence the prevalence of dementias in the population. Instruments that evaluate cognitive functions such as the Mini Mental State Examination (MMSE) are necessary for the investigation of dementia. The supposition that patient score on the MMSE can be influenced by academic level points to the need for establishing cut-off values that take into account educational level. The aim of this study was to review MMSE cut-off values adjusted for schooling in a large southern Brazilian sample.
Method
Demographic data and MMSE scores of 968 subjects, of which 162 were dementia patients and 806 healthy participants, were analyzed. The sample was grouped according to education. The cut-off values were established by ROC Curve analysis.
Results
The total sample mean age was 70.6±7.3 years, and the mean years of education was 7.2±5.3. The cut-off score of 23 points (sensitivity=86%, specificity=83%) was observed as the optimal level to detect dementia on the MMSE instrument for the overall sample. Regarding level of schooling, the cut-off values were: 21 for the illiterate group (sensitivity=93%, specificity=82%), 22 for the low education group (sensitivity=87%, specificity=82%), 23 for the middle education group (sensitivity=86%, specificity=87%) and 24 for the high education group (sensitivity=81%, specificity=87%).
Conclusions
The cut-off values revealed by this analysis, and adjusted for level of schooling, can improve the clinical evaluation of cognitive deficits.
The objective of this study is to establish the effects of age, gender, and education and to provide preliminary normative data for letter and category fluency tasks in the Egyptian Arabic-speaking population. We evaluated 139 cognitively healthy volunteers aged 20–93 by adapting the letter and category verbal fluency tasks for the Egyptian population. On the letter fluency task, mean number of words generated in one-minute beginning with the Arabic letter “Sheen” (pronounced “sh”) was 8.14 words per minute (SD = 3.25). Letter fluency was significantly influenced by education. On category fluency tasks, mean number of animal names generated in one minute was 14.63 words (SD = 5.28). Category fluency was significantly influenced by age and education. We were able identify that age significantly affects category fluency while education significantly affected both letter and category fluency. We were also able to provide preliminary normative data for both tasks in the Egyptian population.
A number of studies has suggested that aging is characterized by a decline in the central executive while the automatic processes (in particular operations by the phonological loop) remain intact. According to interpretation, age differences should be minimal in verbal forward digit span while they should be more important in backward verbal digit span. A sample of 1,000 subjects with ages ranging from 16 years to 79 years was used to test this hypothesis. the results show no significant effect of age on the difference between digit span forward and backward. the theoretical implications of these results are discussed.
The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) is a widely used screening tool for dementia. We aimed to determine the ability of the German version of the 16-item IQCODE with a two-year time frame to discriminate healthy mature control participants (NC) from mild cognitive impairment (MCI) and probable early Alzheimer's disease (AD) patients (all with Mini-mental State Examination (MMSE) scores >or= 24/30) and to optimize diagnostic discriminability by shortening the IQCODE.
453 NC (49.7% women, age = 69.5 years +/- 8.2, education = 12.2 +/- 2.9), 172 MCI patients (41.9% women, age = 71.5 years +/- 8.8, education = 12.3 +/- 3.1) and 208 AD patients (59.1% women, age = 76.0 years +/- 6.4, education = 11.4 +/- 2.9) participated. Stepwise binary logistic regression analyses (LR) were used to shorten the test. Receiver operating characteristic curves (ROC) determined sensitivities, specificities, and correct classification rates (CCRs) for (a) NC vs. all patients; (b) NC vs. MCI; and (c) NC vs. AD patients.
The mean IQCODE was 3.00 for NC, 3.35 for MCI, and 3.73 for AD. CCRs were 85.5% (NC-patient group), 79.9% (NC-MCI), and 90.7% (NC-AD), respectively. The diagnostic discriminability of the shortened 7-item IQCODE (i.e. items 1, 2, 3, 5, 7, 10, 14) was comparable with the longer version (i.e. 7-item CCRs: NC-patient group: 85.3%; NC-MCI: 80.1%, NC-AD: 90.5%).
The German 16-item IQCODE with two-year time frame showed excellent screening properties for MCI and early AD patients. An abbreviated 7-item version demonstrated equally high diagnostic discriminability, thus allowing for more economical screening.
To devise a short bedside cognitive and behavioral battery to assess frontal lobe functions.
The designed battery consists of six subtests exploring the following: conceptualization, mental flexibility, motor programming, sensitivity to interference, inhibitory control, and environmental autonomy. It takes approximately 10 minutes to administer. The authors studied 42 normal subjects and 121 patients with various degrees of frontal lobe dysfunction (PD, n = 24; multiple system atrophy, n = 6; corticobasal degeneration, n = 21; progressive supranuclear palsy, n = 47; frontotemporal dementia, n = 23).
The Frontal Assessment Battery scores correlated with the Mattis Dementia Rating Scale scores (rho = 0.82, p < 0.01) and with the number of criteria (rho = 0.77, p < 0.01) and perseverative errors (rho = 0.68, p < 0.01) of the Wisconsin Card Sorting Test. These variables accounted for 79% of the variance in a stepwise multiple regression, whereas age or Mini-Mental State Examination scores had no significant influence. There was good interrater reliability (kappa = 0.87, p < 0.001), internal consistency (Cronbach's coefficient alpha = 0.78), and discriminant validity (89.1% of cases correctly identified in a discriminant analysis of patients and controls).
The Frontal Assessment Battery is easy to administer at bedside and is sensitive to frontal lobe dysfunction.
To validate a simple bedside test battery designed to detect mild dementia and differentiate AD from frontotemporal dementia (FTD).
Addenbrooke's Cognitive Examination (ACE) is a 100-point test battery that assesses six cognitive domains. Of 210 new patients attending a memory clinic, 139 fulfilled inclusion criteria and comprised dementia (n = 115) and nondementia (n = 24) groups. The composite and the component scores on the ACE for the two groups were compared with those of 127 age- and education-matched controls. Norms and the probability of diagnosing dementia at different prevalence rates were calculated. To evaluate the ACE's ability to differentiate early AD from FTD, scores of the cases diagnosed with dementia with a Clinical Dementia Rating < or = 1 (AD = 56, FTD = 24, others = 20) were compared.
Two cut-off values for the ACE composite score (88 and 83) were of optimal utility depending on the target population. The ACE had high reliability, construct validity, and sensitivity (93%, using 88 as cut-off). Using the lower cut-off of 83, the ACE had a higher sensitivity (82%) and predictive value than the Mini-Mental State Examination for a wide range of dementia prevalence. The ACE differentiated AD from FTD, and the VLOM ratio (derived using component scores: [verbal fluency + language]/[orientation + memory]) of <2.2 for FTD and >3.2 for AD was highly discriminating.
The ACE is a brief and reliable bedside instrument for early detection of dementia, and offers a simple objective index to differentiate AD and FTD in mildly demented patients.
The Mini-mental State Examination (MMSE) has not been validated in Arabic speaking populations. The Brookdale Cognitive Screening Test (BCST) has been developed for use in low schooling populations. We investigated the influence of gender, education and occupation in a cognitively normal community sample which was assessed using an Arabic translation of the MMSE and the BCST.
Cognitively normal subjects (n=266, 59.4% males, mean age (SD): 72.4 (5.5) years) from an Arab community in northern Israel (Wadi Ara) were evaluated. Education was categorized into levels: 1=0-4 years, 2=5-8 years, 3=9-12 years. Effects of gender, education and occupation on MMSE and BCST were analyzed by ANOVA, taking age as a covariate.
The mean MMSE score of males [26.3 (4.1)] was higher than that of females [23.6 (4.2) points]. Two-way ANOVA showed a significant interaction between gender and education on MMSE (p=0.0017) and BCST scores (p=0.0002). The effect of gender on MMSE and BCST was significant in education level 1 (p<0.0001, both tests) and level 2 (p<0.05, both tests). For education level 1, MMSE and BCST scores were higher for males, while both scores were higher for females in education level 2. The effect of occupation was not significant for both genders.
Education and gender influence performance when using the Arabic translation of the MMSE and BCST in cognitively normal elderly. Cognitively normal females with 0-4 years of education scored lower than males. These results should be taken into consideration in the daily use of these instruments in Arabic.
The Mini-Mental State Examination (MMSE) is the most widely used instrument for the screening of cognitive impairment worldwide, but its ability to produce valid estimates of dementia in populations of low socioeconomic status and minimal literacy skills has not been adequately established. The authors investigated the psychometric properties of the MMSE in a community-based sample of older Brazilians.
Cross-sectional one-phase population-based study of all residents of pre-defined areas of the city of Sao Paulo, aged 65 years or over. The Brazilian version of the MMSE was compared with DSM-IV diagnosis of dementia assessed with a harmonized one-phase procedure developed by the 10/66 Dementia Research Group.
Analyses were performed with 1,933 participants of the SPAH study. Receiver operating characteristic analysis showed that the MMSE cut-point of 14/15 was associated with 78.7% sensitivity and 77.8% specificity for the diagnosis of dementia amongst participants with no formal education, and the cut-point 17/18 with 91.9% sensitivity and 89.5% specificity for those with at least 1 year of formal education (areas under the curves 0.87 and 0.94, respectively; P = 0.03). Even with these best fitting cut-points, the MMSE estimate of the prevalence of dementia was four times higher than determined by the DSM-IV criteria. Education, age, sex and income influenced MMSE scores, independently of dementia caseness.
The MMSE is an adequate tool for screening dementia in older adults with minimum literacy skills, but misclassification is unacceptably high for older adults who are illiterate, which has serious consequences for research and clinical practice in low and middle income countries, where the proportion of illiteracy among older adults is high.
PurposeThe underlying pathology for cognitive decline in diabetic patients is uncertain. It was originally linked to vascular causes; however, possible contribution of Alzheimer’s pathology was debated. This study explored the link between salivary amyloid β42 level (as a surrogate marker for Alzheimer’s pathology) and mild cognitive impairment (MCI) among old diabetic patients.MethodsA case–control study included 90 diabetic participants, ≥ 60 years of age, divided into 45 cases with MCI and 45 controls. Patients with history of head trauma, any central nervous system pathology, depression, dementia or delirium, those who received anticholinergic drugs, or refused to participate in the study were excluded. Assessment of the relationship between salivary Aβ42 level and neuropsychological performance was done using a battery consisting of the logical memory test, forward and backward digit span tests, category fluency test, go/no go test, stick design test, and second-order belief.ResultsSalivary Aβ42 levels were higher in MCI diabetics versus controls (P = 0.014), it predicted MCI among aged diabetics, even after adjustment for confounding vascular risk factors. Salivary Aβ42 had moderate accuracy to identify MCI (area under curve = 0.654, P = 0.008). At cut-off ≥ 47.5 pg/ml, sensitivity, specificity, positive predictive value and negative predictive value were 80%, 47%, 60% and 70%, respectively.Conclusion
Current data support that MCI in diabetics, without CNS disorders, is associated with a surrogate marker of Alzheimer’s pathology.
This is the protocol for a review and there is no abstract. The objectives are as follows:
To determine the diagnostic accuracy of the informant-based questionnaire IQCODE, in detection of all-cause (undifferentiated) dementia in adults presenting to secondary-care services.
Where data are available we will describe the following:
• The diagnostic accuracy of IQCODE at various prespecified thresholds. We recognise that various thresholds or cut-off scores have been used to define IQCODE screen positive states. We will describe the properties of IQCODE for the following cut-off scores (rounded where necessary): 3.6; 3.5; 3.4; 3.3. These thresholds have been chosen to represent the range of cut-offs that are commonly used in practice and research; we have been inclusive in our choice of cut-off to maximise available data for review.
• Accuracy of IQCODE for diagnosis of the commonest specific dementia subtype - Alzheimer’s dementia.
• Effects of heterogeneity (see below) on the reported diagnostic accuracy of IQCODE. Potential sources of heterogeneity that we will explore include: age of cohort; case mix of cohort; reason for hospital consultation (dichotomised as 'memory' or 'non-memory' services); technical features of IQCODE; method of dementia diagnosis.
Background
Mild cognitive impairment (MCI) is defined as ‘a cognitive decline greater than that expected for an individual's age and education level but that does not interfere notably with activities of daily life’. The Montreal Cognitive Assessment (MoCA) is a screening test for MCI.Methods
We investigated the performance of the Turkish version of the MoCA in detecting MCI among elderly persons in a rural area, the majority of whom have a low level of education. We evaluated 50 consecutive men referred from an outpatient clinic. Educational level was divided into three categories: group 1, less than primary (<5 years); group 2, primary (5 years); group 3, more than primary (>5 years). We evaluated the effect of education on MoCA scores and compared subjects' test performance among the different categories of education level.ResultsA total of 50 male patients with MCI (mean age: 70.74 ± 7.87) met the inclusion criteria. There were no differences in the total scores based on education or in the subscores for visuospatial/executive function, naming, attention, abstraction and delayed recall. Language was the only domain that showed significant differences between the groups. In post-hoc analysis, differences were found between groups 1 and 3 and between groups 1 and 2. Group 1 had significantly lower scores for language. The repeat subscore for language was significantly lower in group 1 than in group 2. In fluency, there were significant differences between groups 2 and 3 and between group 1 and 3.Conclusion
To our knowledge, this is the first study to analyze the applicability of the Turkish version of MoCA in populations with little education. Our results emphasize the need to adapt the language sections of this test, so it can be easily used in populations with low education levels.
Cognitive screening tests are well-established tools for detecting cognitive impairment, but concerns regarding the influence of premorbid intelligence on patient's performance and cognitive status classification remain. Risk of inaccurate assessment especially affects the elders with high or low premorbid intelligence (who are more likely to be misclassified). The present study examines the influence of premorbid intelligence assessed by the TeLPI (an irregular words reading test) on 2 cognitive screening tests, the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA), in healthy participants and patients with cognitive impairments (mild cognitive impairment and Alzheimer disease). Results show that premorbid IQ influences the MMSE and the MoCA scores in both the groups, predicting variance from 8.4% to 33.2%, according to test and group analyzed. Hence, we propose that whenever the MMSE or the MoCA is used, premorbid IQ evaluation should also be considered to ensure correct interpretation and classification.
The Informant Questionnaire on Cognitive Decline in the Elderly individuals (IQCODE) is a reliable, validated informant-based instrument. Most of the studies well support the validity of the IQCODE in dementia screening, but the sensitivity of the rating scale at the early stage during the course of dementia is limited. In this study, we investigate the utility of the IQCODE for patients with mild cognitive impairment (MCI) and the discriminative power of the IQCODE in patients having MCI with and without functional impairment. The samples included mild Alzheimer disease (AD, N = 280), MCI ([N = 657], further divided into 2 subgroups: patients with MCI having functional impairment [MCI-fi, N = 357] and patients having MCI without functional impairment [MCI-fn, N = 300]), and normal cognition (NC, N = 274). The IQCODE, Mini-Mental State Examination (MMSE), and other neuropsychological tests were administered to all participants. Logistic regression and receiver-operating characteristic (ROC) curves were used to evaluate the diagnostic ability of the IQCODE, compared to the MMSE. The optimal cutoff scores of the IQCODE were 3.19 for the MCI (sensitivity/specificity: 0.979/0.714) and MCI-fn (0.900/0.817), 3.25 for the MCI-fi (0.978/0.701), and 3.31 for mild AD (0.893/0.779), while the MMSE was identical, that is 26, for both MCI and its functional normal and functional impaired subgroups (0.892/0.755, 0.867/0.745, and 0.913/0.745, respectively) and 24 for mild AD (0.807/0.836). The discriminating accuracy of the IQCODE was slightly superior to that of the MMSE but did not reach statistical significance. Our study suggests that the IQCODE might be useful in screening for MCI, with hierarchical scores indicating functional normal or impaired.
When assessing cognitive impairment and dementia, clinicians often seek information from informants to complement the findings from cognitive tests. In recent years, a number of standardized methods have been developed for collecting informant data, but these are not widely known. There are several advantages of using these methods including: everyday relevance, acceptability, useability with nontestable subjects, administration by telephone or mail, potential longitudinal perspective, and greater cross-cultural portability. This review identified 12 scales measuring cognitive impairment as a continuum, and four instruments for diagnosing dementia on the basis of informant data. Research on the psychometric properties of these instruments is reviewed. It is concluded that informant-based measures tap a global factor of cognitive impairment, are highly reliable, correlate with cognitive tests, and discriminate demented from nondemented subjects. Non-cognitive factors and informant characteristics are also likely to influence informants' ratings, but less is known about these influences. Although informant-based methods are a comparatively recent development, existing findings support their use as a complement to cognitive testing, particularly in assessment of dementia.
Understanding of second-order belief structures by 5- and 10-year-old children was assessed in acted stories in which two characters (John and Mary) were independently informed about an object's (ice-cream van's) unexpected transfer to a new location. Hence both John and Mary knew where the van was but there was a mistake in John's second-order belief about Mary's belief: “John thinks Mary thinks the van is still at the old place”. Children's understanding of this second-order belief was tested by asking “Where does John think Mary will go for ice cream?” Correct answers could only be given if John's second-order belief was represented, since all shortcut reasoning based on first-order beliefs would have led to the wrong answer. Results suggested unexpected early competence around the age of 6 and 7 years, shown under optimal conditions when inference of second-order beliefs was prompted.
In a study of 150 adult diabetic patients there was a strong correlation between abdominal circumference and body mass index (BMI) (r = 0.85).1 The authors went on to report that the correlation differed in different BMI categories as shown in the table.⇓
View this table:
Correlation between abdominal circumference and body mass indeed (BMI) in 1450 adult patients with diabetes
The authors’ interpretation of these data was that in patients with low or high BMI values (BMI 35 kg/m2) the correlation was strong, but in those with BMI values between 25 and 35 kg/m2 the correlation was weak or missing. They concluded that measuring abdominal circumference is of particular importance in subjects with the most frequent BMI category (25 to 35 kg/m2).
When we restrict the range of one of the variables, a correlation coefficient will be reduced. For …
SYNOPSIS
The IQCODE is a questionnaire which asks an informant about changes in an elderly person's everyday cognitive function. The questionnaire aims to assess cognitive decline independent of pre-morbid ability. In the present study, the IQCODE was administered to a sample of 613 informants from the general population. In addition, the questionnaire was administered to informants of 309 dementing subjects who had filled it out one year previously. A principal components analysis, using the general population sample, confirmed that the IQCODE measures a general factor of cognitive decline. The questionnaire was found to have high internal reliability in the general population sample (alpha = 0·95) and reasonably high test-retest reliability over one year in the dementing sample ( r = 0·75). The total IQCODE score, as well as each of the 26-items, was found to discriminate well between the general population and dementing samples. The correlation with education was quite small ( r = – 0·13), indicating that contamination by premorbid ability is not a problem.
To explore an alternative method of screening for dementia in Thai elderly people who have a low educational level. The Informant Questionnaire on Cognitive Decline in the elderly (IQCODE) is used as the screening test.
A community based population of elderly subjects in Bangkok including 87 normal subjects and 73 demented elderly people were studied. Their ages ranged from 52 to 85 years old. The majority of the elderly people had had four years or less of primary-education. Dementia was diagnosed independently by DSM IV criteria. A short form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), a short form, was administered to informants of the elderly by trained medical personnel. The Thai Mini Mental State Examination (TMSE) was also administered to these subjects and compared with the IQCODE. SPSS 9.0 was used for statistical analysis.
The IQCODE showed a negative correlation with the TMSE (n=160, r=-0.679, p<0.001). The area under the receiver operating characteristic curve (ROC) of the IQCODE was larger than that of TMSE (0.928 vs 0.814). On logistic regression analysis, there were only three questions that contributed to the diagnosis that showed statistical significance. These questions are remembering what day and month it is, learning how to use a new gadget and handling other everyday arithmetic problems. Applying the new formula (z-score), these three questions showed a sensitivity of 84.90 per cent, and a specificity of 92 per cent for the diagnosis of dementia.
Informants' perceptions of cognitive impairment of the elderly can be reliably applied as a screening instrument for dementia in the Thai population with a variety of educational levels. A short form of the IQCODE using selected questions can be administered with good diagnostic sensitivity and specificity.
The concept of cognitive impairment intervening between normal ageing and very early dementia has been in the literature for many years. Recently, the construct of mild cognitive impairment (MCI) has been proposed to designate an early, but abnormal, state of cognitive impairment. MCI has generated a great deal of research from both clinical and research perspectives. Numerous epidemiological studies have documented the accelerated rate of progression to dementia and Alzheimer's disease (AD) in MCI subjects and certain predictor variables appear valid. However, there has been controversy regarding the precise definition of the concept and its implementation in various clinical settings. Clinical subtypes of MCI have been proposed to broaden the concept and include prodromal forms of a variety of dementias. It is suggested that the diagnosis of MCI can be made in a fashion similar to the clinical diagnoses of dementia and AD. An algorithm is presented to assist the clinician in identifying subjects and subclassifying them into the various types of MCI. By refining the criteria for MCI, clinical trials can be designed with appropriate inclusion and exclusion restrictions to allow for the investigation of therapeutics tailored for specific targets and populations.
Early dementia diagnosis is aided by the use of brief screening tests; scores can be biased by patient and informant characteristics such as age, gender and education.
To assess whether the General Practitioner's Assessment of Cognition (GPCOG), a brief screening tool for detecting cognitive impairment comprising a patient cognitive test and questions to an informant, is biased by patient and informant characteristics.
Sixty-seven general practitioners recruited consecutive patients (with informants). Patients were subsequently assessed by a research psychologist, and DSM-IV diagnoses assigned following a case-conference.
Primary Care.
Two hundred and eighty three home-dwelling individuals, 11.3% of whom were aged 50-74 years with suspected memory problems and the rest aged 75 or more.
The GPCOG, Cambridge Mental Disorder of the Elderly Examination cognitive scale (CAMCOG), Geriatric Depression Scale (GDS), and the SF-12 Health Survey (SF-12) were administered and demographic data were collected and consensus DSM-IV diagnoses of dementia made. Relationships between patient and informant characteristics and the GPCOG measure were examined using Pearson correlations and linear regression analyses.
There were correlations in GPCOG-patient scores with age, education and depression scores but on regression analysis only age was associated with the GPCOG-patient section. The GPCOG-informant section was free of bias.
The GPCOG has advantages for use in primary care and is free of many biases common in other scales.
Visuoconstructional ability is an important domain for assessment in dementia. Use of graphomotor measures dominate this area; however, participants with low education produce results that cannot be easily interpreted. Our objective was to develop and validate a nongraphomotor assessment of visuoconstructional ability for use in dementia evaluations in persons with low or no education. In a longitudinal, population-based study of dementia among Yoruba residents of Ibadan, Nigeria aged 65 years and older, participants underwent clinical assessment with a battery of cognitive tests and consensus diagnosis. Performance on two visuoconstructional tests, Constructional Praxis and Stick Design, were compared. Gender, age, and education affected performance on both tests. The Stick Design test was more acceptable than Constructional Praxis as measured by the number of participants with total test failure (3.9% vs. 15.1%). The Stick Design test was significantly more sensitive to cognitive impairment and dementia than the Constructional Praxis test. We conclude that Stick Design is a reasonable test of visuoconstructional ability in older cohorts with very limited educational exposure and literacy.
The Mini-Mental State Examination (MMSE) is commonly used as a screening tool to detect dementia. However, it performs poorly in identifying persons with mild neurocognitive disorder. The Saint Louis University Mental Status (SLUMS) examination is a 30-point screening questionnaire that tests for orientation, memory, attention, and executive functions.
The objective of this study was to compare SLUMS and the MMSE for detecting dementia and mild neurocognitive disorder (MNCD) using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria.
Patients at the Veterans' Affairs Geriatric Research, Education and Clinical Center, St. Louis, MO (N = 702) were clinically classified as having normal cognitive functioning, MNCD, or dementia based on DSM-IV criteria. The SLUMS and MMSE were administered for comparison.
Mean age was 75.3 years (standard deviation: 5.5). Regarding education, 62.4% of the sample had at least completed high school and 30.6% had not. Sensitivity and specificity were calculated and receiver operator curves (ROCs) generated for SLUMS and MMSE as a function of diagnosis (MCND versus dementia) and education. Both the SLUMS and MMSE produced acceptable ROCs for the diagnosis of dementia, but the ROCs for SLUMS were better than the MMSE for the diagnosis of MNCD in both education groups.
These results suggest that the SLUMS and MMSE have comparable sensitivities, specificities, and area under the curve in detecting dementia. Although the definition of MNCD is controversial, the authors believe that the SLUMS is possibly better at detecting mild neurocognitive disorder, which the MMSE failed to detect, but this needs to be further investigated.
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