BRIEF METHODOLOGICAL REPORTS
Veterans Affairs Saint Louis University Mental Status Examination Compared with the Montreal Cognitive Assessment and the Short Test of Mental Status Lenise A. Cummings-Vaughn, MD,*† Neeraja N. Chavakula, MBBS,* Theodore K. Malmstrom, PhD,†‡ Nina Tumosa, PhD,*† John E. Morley, MB, BCh,*† and Dulce M. Cruz-Oliver, MD†
OBJECTIVES: To compare the ability of the Veterans Affairs Saint Louis University Mental Status (SLUMS) examination to detect mild cognitive impairment (MCI) and dementia according to the Clinical Dementia Rating Scale (CDR) with that of two other well-known screening instruments, the Montreal Cognitive Assessment (MoCA) and the Short Test of Mental Status (STMS). DESIGN: Cross-sectional validation study. SETTING: Saint Louis Veterans Affairs Medical Center Geriatric Research Education and Clinical Center. PARTICIPANTS: Veterans aged 60 and older (median 78.5) with a high school education or more (n = 136). MEASUREMENTS: Participants were administered the SLUMS examination, the MoCA, and the STMS in random order. A blinded test administrator administered the CDR in a separate session. Receiver operating characteristic (ROC) curves were used to assess the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the SLUMS examination, the MoCA, and the STMS for MCI, dementia, and MCI or dementia. ROC contrasts were used to statistically compare the area under the ROC curve (AUC) for the screening tests’ ability to detect cognitive dysfunction according to the CDR. RESULTS: ROC contrasts demonstrated that the AUCs for detecting MCI (SLUMS examination 0.74, MoCA 0.77, STMS 0.77), dementia (SLUMS examination 0.98, MoCA 0.96, STMS 0.97), and MCI or dementia (SLUMS examination 0.82, MoCA 0.83, STMS 0.84) were equivalent. Sensitivity, specificity, PPV, and NPV were similar
From the *Jefferson Barracks Division, Geriatric Research Education and Clinical Center, Veterans Affairs Saint Louis Health System, †Division of Geriatric Medicine, Department of Internal Medicine, School of Medicine, Saint Louis University, and ‡Department of Neurology and Psychiatry, School of Medicine, Saint Louis University, Saint Louis, Missouri. Address correspondence to Dulce M. Cruz-Oliver, Division of Geriatrics, Department of Internal Medicine, Saint Louis University, 1402 South Grand Blvd, M238, St Louis, MO 63104. E-mail:
[email protected] DOI: 10.1111/jgs.12874
JAGS 62:1341–1346, 2014 © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society
across measures of MCI, dementia, and MCI or dementia according to the CDR. CONCLUSION: The SLUMS examination has validity similar to that of the MoCA and STMS for the detection of MCI, dementia, and MCI or dementia according to the CDR. J Am Geriatr Soc 62:1341–1346, 2014.
Key words: SLUMS examination; cognitive impairment; MoCA; CDR
dementia;
mild
T
here has been an increasing emphasis on the detection of mild cognitive impairment (MCI) in recent years, due in part to studies finding that MCI often progresses to Alzheimer’s disease (AD).1,2 The original definition of MCI referred to persons with memory loss but preserved general function (intact basic activities of daily living or minimal impairment in instrumental function).3 Recent reports indicate that approximately 12% of individuals with MCI progress to dementia and that 106 cases more per 1,000 person-years progress to dementia than of persons without MCI.4,5 Several screening instruments have been developed for the purpose of detecting MCI and dementia,6–13 but only the Mini-Mental State Examination (MMSE), Mini-Cog, Montreal Cognitive Assessment (MoCA), Short Test of Mental Status (STMS), and Veterans Affairs Saint Louis University Mental Status (SLUMS) examination have been tested to detect MCI. Of these, only the SLUMS examination and MoCA have been shown to be sensitive enough to detect MCI.14 For example, the MMSE has a diagnostic threshold for dementia of 0.90. Participants were divided into three groups identified as having normal cognition (n = 51), MCI (n = 57), or dementia (n = 28) based on CDR scores determined during the blinded study evaluation. The St. Louis VAMC institutional review board approved this study.
Cognitive Testing METHODS Study Design This cross-sectional validation study was performed at the Geriatric Research, Education, and Clinical Center (GRECC), Geriatric Evaluation Medical Unit (GEMU), Rehabilitation Unit and Community Living Center (CLC) at Jefferson Barracks Division of the VA Saint Louis Health System. Subjects were recruited during a routine visit or while admitted to any of the sites mentioned. Subjects who were unable to provide informed consent because of incompetency (SLUMS examination High school Number of prescribed drugs, mean SD Number of prescribed anticholinergic drugs, mean SD Had prescribed acetylcholinesterase inhibitor,% Number of comorbidities (1 missing), mean SDe Katz index score, mean SD Geriatric Depression Scale score, mean SD Descriptive data according to cognitive status, mean SD Saint Louis University Mental Status Montreal Cognitive Assessment Short Test of Mental Status
98 77.0 7.5
97 78.8 6.7
100 81.6 9.1
26 75 7.6 0.5 2 5.1 5.7 1.5
47 53 9.3 1.0 9 7.3 5.7 2.9
a
5.9 0.9 3.1 0.6 1.7
26.9 2.5 25.8 2.9 33.8 3.0
4.8 1.0 4.2 0.6 2.9
23.9 3.8 22.8 3.3 30.2 4.4
57 43 8.1 1.1 36 11.0 4.8 3.7
P-Valuea
.58 .04c .01
4.2 0.7 4.1 1.8 2.7
.23 .003b,c