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Peer-reviewedCC BY-NC-ND 4.0Alzheimer's & Dementia

Evaluating the accuracy of brief cognitive assessments for the early detection of cognitive impairment in adults across primary and specialty care settings: A systematic review and meta‐analysis

  • Jennifer Loveless1
  • Lauren Pilcher2
  • Corey J. Bolton3
  • Dylan X. Guan4
  • Uzochukwu Imo5
  • Chimkaha G. A. Ngubo6
  • Mary Beth McAteer7
  • Olivia Urquhart8
  • Subhashini K Rangarajan9
  • Lorie S. Kim10
  • Katarina Sako11
  • Belinda Tang12
8 more authors
  • Yara Yakoub13,14
  • Luiza S. Machado15
  • Fred Ko16,17
  • Dorene Rentz18
  • Sarah Pahlke19
  • Simin Mahinrad19
  • Heather Snyder19
  • Malavika P. Tampi19
19 affiliations
  1. 1Lovevidence LLC Spring Texas USA
  2. 2American Academy of Pediatrics Itasca Illinois USA
  3. 3Department of Medicine Vanderbilt University Medical Center Nashville Tennessee USA
  4. 4Cumming School of Medicine University of Calgary Calgary Alberta Canada
  5. 5College of Medicine University of Ibadan University College Hospital Ibadan Oyo Nigeria
  6. 6University of Roehampton London UK
  7. 7Virginia Mason Medical Center Seattle Washington USA
  8. 8School of Dental Medicine University of Pennsylvania Philadelphia Pennsylvania USA
  9. 9National Institute of Mental Health and Neurosciences (NIMHANS) Bengaluru Karnataka India
  10. 10Harbor‐UCLA Medical Center Torrance California USA
  11. 11Department of Geriatrics SUNY Upstate Medical University Syracuse New York USA
  12. 12University of California Los Angeles California USA
  13. 13Douglas Mental Health University Institute Montreal Quebec Canada
  14. 14Faculty of Medicine, Integrated Program in Neuroscience McGill University Montreal Quebec Canada
  15. 15Department of Psychiatry and Neurochemistry The Sahlgrenska Academy University of Gothenburg Mölndal Sweden
  16. 16Division of Geriatric Medicine, Department of Medicine Larner College of Medicine at The University of Vermont Burlington Vermont USA
  17. 17University of Vermont Center on Aging Burlington Vermont USA
  18. 18Harvard Medical School Brigham and Women's Hospital Boston Massachusetts USA
  19. 19Alzheimer's Association Chicago Illinois USA
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Abstract

BACKGROUND: This systematic review and meta‐analysis aimed to assess the accuracy of brief (i.e., ≤15 minutes), freely available cognitive tests for the early detection of cognitive impairment (including mild cognitive impairment and dementia) in adults 55 years and older in primary and specialty care.

METHODS: A systematic search of MEDLINE, Embase, and Cochrane Library databases was conducted to identify studies published between January 1999 and August 2024 that evaluated the accuracy of brief, freely available cognitive tests for early detection of cognitive impairment. The tests included 5‐Cog, Eight‐item Informant Interview to Differentiate Aging and Dementia (AD8), General Practitioner assessment of Cognition (GPCOG), Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), Mini‐Cog, Memory Impairment Screen (MIS), Montreal Cognitive Assessment (MoCA), Quick Dementia Rating System (QDRS), Rowland Universal Dementia Assessment Scale (RUDAS), and Saint Louis University Mental Status (SLUMS). Though widely used, the Mini‐Mental State Examination did not meet eligibility criteria and was not considered. Accuracy measures were extracted from eligible studies and pooled where possible. Risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies 2, and certainty of evidence was assigned according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.

RESULTS: Forty‐seven studies evaluating 10 index tests, including short versions of IQCODE and MoCA, were included. Test accuracy varied widely among tests and data pooling was not possible for most analyses. Studies conducted in both primary and specialty care were identified for AD8, Mini‐Cog, MIS, MoCA, QDRS, Short IQCODE, and SLUMS, while evidence for IQCODE, short MoCA, and RUDAS was limited to a single setting. No studies meeting eligibility criteria were found for 5‐Cog and GPCOG. Across all tests, in primary care, sensitivity ranged from 0.17 to 0.98, and specificity ranged from 0.10 to 0.98. Across all tests and assuming the same prevalence in specialty care, sensitivity ranged from 0.73 to 0.97, and specificity ranged from 0.45 to 0.90.

CONCLUSION: This systematic review provides a synthesis of the evidence on the accuracy of brief, freely available cognitive assessment tools for the early detection of cognitive impairment in primary and specialty care. Results from primary care settings informed the development of evidence‐based recommendations presented in the accompanying clinical practice guideline on the use of brief cognitive tests in primary care.

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Cite

BibTeXRIS
BibTeX
@article{loveless2026evaluating,
  title = {{Evaluating the accuracy of brief cognitive assessments for the early detection of cognitive impairment in adults across primary and specialty care settings: A systematic review and meta‐analysis}},
  author = {Jennifer Loveless and Lauren Pilcher and Corey J. Bolton and Dylan X. Guan and Uzochukwu Imo and Chimkaha G. A. Ngubo and Mary Beth McAteer and Olivia Urquhart and Subhashini K Rangarajan and Lorie S. Kim and Katarina Sako and Belinda Tang and Yara Yakoub and Luiza S. Machado and Fred Ko and Dorene Rentz and Sarah Pahlke and Simin Mahinrad and Heather Snyder and Malavika P. Tampi},
  journal = {Alzheimer's \& Dementia},
  year = {2026},
  month = nov,
  doi = {10.1002/alz.71674},
  url = {https://doi.org/10.1002/alz.71674},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Evaluating the accuracy of brief cognitive assessments for the early detection of cognitive impairment in adults across primary and specialty care settings: A systematic review and meta‐analysis
AU  - Jennifer Loveless
AU  - Lauren Pilcher
AU  - Corey J. Bolton
AU  - Dylan X. Guan
AU  - Uzochukwu Imo
AU  - Chimkaha G. A. Ngubo
AU  - Mary Beth McAteer
AU  - Olivia Urquhart
AU  - Subhashini K Rangarajan
AU  - Lorie S. Kim
AU  - Katarina Sako
AU  - Belinda Tang
AU  - Yara Yakoub
AU  - Luiza S. Machado
AU  - Fred Ko
AU  - Dorene Rentz
AU  - Sarah Pahlke
AU  - Simin Mahinrad
AU  - Heather Snyder
AU  - Malavika P. Tampi
PY  - 2026
DA  - 2026/11/04
JO  - Alzheimer's & Dementia
DO  - 10.1002/alz.71674
UR  - https://doi.org/10.1002/alz.71674
AB  - BACKGROUND: This systematic review and meta‐analysis aimed to assess the accuracy of brief (i.e., ≤15 minutes), freely available cognitive tests for the early detection of cognitive impairment (including mild cognitive impairment and dementia) in adults 55 years and older in primary and specialty care.  METHODS: A systematic search of MEDLINE, Embase, and Cochrane Library databases was conducted to identify studies published between January 1999 and August 2024 that evaluated the accuracy of brief, freely available cognitive tests for early detection of cognitive impairment. The tests included 5‐Cog, Eight‐item Informant Interview to Differentiate Aging and Dementia (AD8), General Practitioner assessment of Cognition (GPCOG), Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), Mini‐Cog, Memory Impairment Screen (MIS), Montreal Cognitive Assessment (MoCA), Quick Dementia Rating System (QDRS), Rowland Universal Dementia Assessment Scale (RUDAS), and Saint Louis University Mental Status (SLUMS). Though widely used, the Mini‐Mental State Examination did not meet eligibility criteria and was not considered. Accuracy measures were extracted from eligible studies and pooled where possible. Risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies 2, and certainty of evidence was assigned according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.  RESULTS: Forty‐seven studies evaluating 10 index tests, including short versions of IQCODE and MoCA, were included. Test accuracy varied widely among tests and data pooling was not possible for most analyses. Studies conducted in both primary and specialty care were identified for AD8, Mini‐Cog, MIS, MoCA, QDRS, Short IQCODE, and SLUMS, while evidence for IQCODE, short MoCA, and RUDAS was limited to a single setting. No studies meeting eligibility criteria were found for 5‐Cog and GPCOG. Across all tests, in primary care, sensitivity ranged from 0.17 to 0.98, and specificity ranged from 0.10 to 0.98. Across all tests and assuming the same prevalence in specialty care, sensitivity ranged from 0.73 to 0.97, and specificity ranged from 0.45 to 0.90.  CONCLUSION: This systematic review provides a synthesis of the evidence on the accuracy of brief, freely available cognitive assessment tools for the early detection of cognitive impairment in primary and specialty care. Results from primary care settings informed the development of evidence‐based recommendations presented in the accompanying clinical practice guideline on the use of brief cognitive tests in primary care.
SN  - 1552-5260
SN  - 1552-5279
ER  -