Diagnostic Precision in the Detection of Mild Cognitive Impairment: A Comparison of Two Approaches

• Published in: The American journal of geriatric psychiatry 2022-01, Vol.30 (1), p.54-64
• Main Authors: Weinstein, Andrea M., Gujral, Swathi, Butters, Meryl A., Bowie, Christopher R., Fischer, Corinne E., Flint, Alastair J., Herrmann, Nathan, Kennedy, James L., Mah, Linda, Ovaysikia, Shima, Pollock, Bruce G., Rajji, Tarek K., Mulsant, Benoit H.
• Format: Article
• Language: English
• Subjects: Aged; Alzheimer Disease - complications; Alzheimer Disease - diagnosis; Alzheimer Disease - genetics; Alzheimer's; Alzheimer's disease; cognition; Cognition & reasoning; Cognitive ability; Cognitive Dysfunction - psychology; Cross-Sectional Studies; Dementia; Depressive Disorder, Major - complications; Depressive Disorder, Major - diagnosis; Disease Progression; Geriatric psychiatry; Humans; mild cognitive impairment; Neuropsychological Tests; Older people; Transcranial Direct Current Stimulation
• ISSN: 1064-7481; 1545-7214
• DOI: 10.1016/j.jagp.2021.04.004

•The primary question addressed by this study:This study compared diagnostic rates and clinical predictors of discrepancies between diagnoses conferred via: 1) a comprehensive neuropsychological evaluation and National Institute on Aging–Alzheimer's Association (NIA-AA) criteria versus 2) a cognitive screener and Diagnostic Statistical Manual of Mental Disorders (DSM-5) criteria.•The main finding of this study: There were 103 (23.8%) discrepant cases, with most (91; 88.3%) of these discrepant cases reflecting more impairment with the detailed neuropsychological testing and NIA-AA criteria. Discrepancies were more likely in individuals with a history of major depressive disorder (MDD) or who had at least one ApoE4 allele.•The meaning of the finding: The NIA-AA criteria, in conjunction with comprehensive neuropsychological testing, identified a greater prevalence of cognitive impairment than DSM-5 criteria, in conjunction with the Montreal Cognitive Assessment. Detailed neuropsychological evaluations are recommended for older adults who have a history of MDD or a genetic vulnerability to dementia. This study compared diagnostic rates and clinical predictors of discrepancies between diagnoses conferred via: 1) a comprehensive neuropsychological evaluation and National Institute on Aging–Alzheimer's Association (NIA-AA) criteria versus 2) a cognitive screener and Diagnostic Statistical Manual of Mental Disorders (DSM-5) criteria. Cross-sectional examination of baseline data from the Prevention of Alzheimer's dementia (AD) using Cognitive remediation and transcranial direct current stimulation in Mild Cognitive Impairment (MCI) and Depression (PACt-MD; ClinicalTrials.gov Identifier: NCT02386670) trial. Five geriatric psychiatry and memory clinics located at academic hospitals affiliated with the Department of Psychiatry, University of Toronto. Older adults (N = 431) with a history of major depressive disorder (MDD) in remission, MCI, or both. Main outcome was a comparison of NIA-AA diagnostic rates of MCI or dementia versus DSM-5 rates of mild or major neurocognitive disorder. Secondary analyses examined demographic, race, gender, premorbid intellectual ability, psychosocial, health-related, and genetic predictors of discrepancy between DSM-5 and NIA-AA diagnoses. There were 103 (23.8%) discrepant cases, with most (91; 88.3%) of these discrepant cases reflecting more impairment with the detailed neuropsychological testing and NIA-AA criteria. Discrepancies were