What is the most accurate test for Mild Cognitive Impairment and Dementia? Three things to know.

70% of Americans say they would rather know if their memory changes were normal, or something more serious… well which test?

While there isn't a single, universally accepted "most accurate" test for detecting mild cognitive impairment (MCI), the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) have been the go-to's, among dozens of digital and pen and paper tests.

However, our literature review below shows the MCI Screen, by the Embic Corporation, has the highest accuracy in published medical literatures with both highest sensitivity and highest specificity in detecting Mild Cognitive Impairment and Dementia.

• MCI Screen has the highest accuracy in published medical literatures with both high sensitivity and high specificity.
• May be administered by a clinician or a trained office staff.
• Fully online guided administration of a 10-minute assessment that enforces consistency across different test administrators.

Three things to know to help decide which test (assuming our readers are not neurologists):

First, Primary Modes of Administration. The three primary modes of test administration: pen-and-paper, computer guided, and computerized. Each mode requires a different setting, training, and up-front financial investment. It is also important to note that some tests do not have or may not have readily available normative data to adjust the score for age, gender, race, and education

Second, Test Accuracy. In the literature and in practice, it is generally considered important to consider both sensitivity (ability to identify impairment) and specificity (ability to identify normal). Additionally, it is important to understand its accuracy in different stages of cognitive impairment (e.g., mild cognitive impairment, mild dementia, moderate dementia

Third, big barriers remain in patients not wanting to know, and in the Clinical Care Settings.

Huge stigma abounds for patients not wanting to know if they have an MCI or Dementia diagnosis – fear of losing employment, health insurance, and generally being afraid are powerful forces of inertia, despite recent drugs coming on the market (See Leqembi from Easi/Biogen, and Kisunla from Lilly)

Several physician concerns and financial barriers have been identified in implementing cognitive assessment in clinical care settings. These include:

• High rates of false positive or negatives of the assessment tools
• Lack of training or confidence in performing such assessments
• Lack of time during patient visits
• Lack of financial reimbursement

Remember, consulting with a healthcare professional is crucial for getting a proper diagnosis of MCI. They can consider your specific situation and use a combination of tests to make the most accurate assessment.

Table. MCI Screen Comparison to Commonly Used Brief Cognitive Assessments

References

1. Alzheimer’s Association. 2024 Alzheimer’s Disease Facts and Figures. Alzheimer’s Dement 2024;20(5).
2. A Billing and Coding: Cognitive Assessment and Care Plan Service (CMS website: https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=59036&ver=13&)
3. Cognitive Assessment & Care Plan Services (CMS website: https://www.cms.gov/medicare/payment/fee-schedules/physician/cognitive-assessment)
4. Alzheimer’s Association. 2019 Alzheimer’s Disease Facts and Figures. Alzheimer’s Dement 2019;15(3):321-87.
5. Cordell CB, Borson S, Boustani M, et al. Medicare Detection of Cognitive Impairment Workgroup. Alzheimer's Association recommendations for operationalizing the detection of cognitive impairment during the Medicare Annual Wellness Visit in a primary care setting. Alzheimer’s Dement. 2013 Mar;9(2):141-50.
6. Athilingam P, Visovsky C, Elliott AF, Rogal PJ. Cognitive screening in persons with chronic diseases in primary care: challenges and recommendations for practice. Am J Alzheimers Dis Other Demen. 2015 Sep;30(6):547-58.
7. Liss JL, Seleri Assunção S, Cummings J, et al. Practical recommendations for timely, accurate diagnosis of symptomatic Alzheimer's disease (MCI and dementia) in primary care: a review and synthesis. J Intern Med. 2021 Aug;290(2):310-334.
8. de Levante Raphael D. The Knowledge and Attitudes of Primary Care and the Barriers to Early Detection and Diagnosis of Alzheimer's Disease. Medicina (Kaunas). 2022 Jul 7;58(7):906.

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