Joyce Y.C. Chan

Cognitive Tests to Detect Dementia A Systematic Review and Meta-analysis

IMPORTANCE Dementia is a global public health problem. The Mini-Mental State Examination (MMSE) is a proprietary instrument for detecting dementia, but many other tests are also available. OBJECTIVE To evaluate the diagnostic performance of all cognitive tests for the detection of dementia. DATA SOURCES Literature searches were performed on the list of dementia screening tests in MEDLINE, EMBASE, and PsychoINFO from the earliest available dates stated in the individual databases until September 1, 2014. Because Google Scholar searches literature with a combined ranking algorithm on citation counts and keywords in each article, our literature search was extended to Google Scholar with individual test names and dementia screening as a supplementary search. STUDY SELECTION Studies were eligible if participants were interviewed face to face with respective screening tests, and findings were compared with criterion standard diagnostic criteria for dementia. Bivariate random-effects models were used, and the area under the summary receiver-operating characteristic curve was used to present the overall performance. MAIN OUTCOMES AND MEASURES Sensitivity, specificity, and positive and negative likelihood ratios were the main outcomes. RESULTS Eleven screening tests were identified among 149 studies with more than 49,000 participants. Most studies used the MMSE (n = 102) and included 10,263 patients with dementia. The combined sensitivity and specificity for detection of dementia were 0.81 (95% CI, 0.78-0.84) and 0.89 (95% CI, 0.87-0.91), respectively. Among the other 10 tests, the Mini-Cog test and Addenbrookes Cognitive Examination-Revised (ACE-R) had the best diagnostic performances, which were comparable to that of the MMSE (Mini-Cog, 0.91 sensitivity and 0.86 specificity; ACE-R, 0.92 sensitivity and 0.89 specificity). Subgroup analysis revealed that only the Montreal Cognitive Assessment had comparable performance to the MMSE on detection of mild cognitive impairment with 0.89 sensitivity and 0.75 specificity. CONCLUSIONS AND RELEVANCE Besides the MMSE, there are many other tests with comparable diagnostic performance for detecting dementia. The Mini-Cog test and the ACE-R are the best alternative screening tests for dementia, and the Montreal Cognitive Assessment is the best alternative for mild cognitive impairment.

Can computer-assisted cognitive remediation improve employment and productivity outcomes of patients with severe mental illness? A meta-analysis of prospective controlled trials

BACKGROUND Computer-assisted cognitive remediation (CACR) has been demonstrated to enhance cognition of patients with severe mental illness (SMI). Patients with improved cognitive skills may find it easier to be employed, and the ability to maintain employment is an important sign of recovery. AIM To assess whether CACR is an effective method to enhance work-related outcomes in patients with SMI. METHOD Prospective controlled trials evaluating CACR on productivity outcomes were systematically identified from the OVID databases. Employment rates, total days of work in a year, and total annual earnings were defined as the productivity outcomes. RESULTS Nine trials were published between 2005 and 2014 and were conducted in the United States, Germany, Italy, Singapore and Japan. A total of 740 patients with mean age of 36.4 years were included. The duration of CACR ranged from 2 months to 2 years, and the patients were followed-up from 1 year to 3 years. Patients receiving CACR showed 20% higher employment rate (95% CI = 5%-35%), worked 19.5 days longer in a year (95% CI = 2.5-36.6 days), and earned US

Detection of language boundary in code-switching utterances by bi-phone probabilities

959 more in total annual earnings (95% CI = US

Systematic review with meta‐analysis: faecal occult blood tests show lower colorectal cancer detection rates in the proximal colon in colonoscopy‐verified diagnostic studies

285 to US

Automatic Recognition of Cantonese-English Code-Mixing Speech

1634) than those not receiving CACR. CONCLUSION CACR can enhance productivity outcomes for patients with SMI, including higher employment rate, longer duration of work and higher income. The economic benefit of CACR can enhance the quality of life for patients with SMI, and may reduce financial burden on the health and welfare system. Therefore, CACR can be recommended and incorporated into regular vocational rehabilitation programs.

Comparison of diagnostic performance of Two-Question Screen and 15 depression screening instruments for older adults: systematic review and meta-analysis

In this paper, we present an effective method to detect the language boundary (LB) in code-switching utterances. The utterances are mainly produced in Cantonese, a commonly used Chinese dialect, whilst occasionally English words are inserted between Cantonese words. Bi-phone probabilities are calculated to measure the confidence that the recognized phones are in Cantonese. Two sets of context-independent mono-phone models are trained by monolingual Cantonese and monolingual English data separately. Both knowledge-based and data-driven model selection approaches are studied in order to retain the language-dependent characteristics and to merge duplicated phone sets between the two languages. The LB detection accuracy is 75.12% for utterances that contain one single code-switching word or phrase.

Response to the Letter to the Editor by Shinji Matsunaga “Combination Therapy Showed Limited Superiority Over Monotherapy for Alzheimer Disease: A Meta-analysis of 14 Randomized Trials”

The performance of faecal occult blood tests (FOBTs) to screen proximally located colorectal cancer (CRC) has produced inconsistent results.

Time to Treatment Initiation in People With Alzheimer Disease: A Meta-Analysis of Randomized Controlled Trials.

Code-mixing is a common phenomenon in bilingual societies. It refers to the intra-sentential switching of two different languages in a spoken utterance. This paper presents the first study on automatic recognition of Cantonese-English code-mixing speech, which is common in Hong Kong. This study starts with the design and compilation of code-mixing speech and text corpora. The problems of acoustic modeling, language modeling, and language boundary detection are investigated. Subsequently, a large-vocabulary code-mixing speech recognition system is developed based on a two-pass decoding algorithm. For acoustic modeling, it is shown that cross-lingual acoustic models are more appropriate than language-dependent models. The language models being used are character tri-grams, in which the embedded English words are grouped into a small number of classes. Language boundary detection is done either by exploiting the phonological and lexical differences between the two languages or is done based on the result of cross-lingual speech recognition. The language boundary information is used to re-score the hypothesized syllables or words in the decoding process. The proposed code-mixing speech recognition system attains the accuracies of 56.4% and 53.0% for the Cantonese syllables and English words in code-mixing utterances.

COMBINATION THERAPY SHOWED NO ADDITIONAL BENEFIT OVER MONOTHERAPY FOR ALZHEIMER’S DISEASE: A NETWORK META-ANALYSIS OF 76 RANDOMIZED CONTROLLED TRIALS

BackgroundScreening for depression in older adults is recommended.AimsTo evaluate the diagnostic accuracy of the Two-Question Screen for older adults and compare it with other screening instruments for depression.MethodWe undertook a literature search for studies assessing the diagnostic performance of depression screening instruments in older adults. Combined diagnostic accuracy including sensitivity and specificity were the primary outcomes. Potential risks of bias and the quality of studies were also assessed.ResultsA total of 46 506 participants from 132 studies were identified evaluating 16 screening instruments. The majority of studies (63/132) used various versions of the Geriatric Depression Scale (GDS) and 6 used the Two-Question Screen. The combined sensitivity and specificity for the Two-Question Screen were 91.8% (95% CI 85.2-95.6) and 67.7% (95% CI 58.1-76.0), respectively; the diagnostic performance area under the curve (AUC) was 90%. The Two-Question Screen showed comparable performance with other instruments, including clinician-rated scales. The One-Question Screen showed the lowest diagnostic performance with an AUC of 78%. In subgroup analysis, the Two-Question Screen also had good diagnostic performance in screening for major depressive disorder.ConclusionsThe Two-Question Screen is a simple and short instrument for depression screening. Its diagnostic performance is comparable with other instruments and, therefore, it would be favourable to use it for older adult screening programmes.

COMPARISON OF COMPUTERIZED AND PAPER-AND-PENCIL MEMORY TESTS IN DETECTION OF MILD COGNITIVE IMPAIRMENT AND DEMENTIA: A SYSTEMATIC REVIEW AND META-ANALYSIS OF DIAGNOSTIC STUDIES

In Reply: We thank DrMatsunaga for his interest in our work,1 and for the points raised in his letter. We also appreciate JAMDA for inviting us to respond on this controversial topic of combination therapy for Alzheimer disease. We disagree with Dr Matsunaga’s description of methodology flaws. His comments appear to concern the references used in our article, and we had double-checked all of his references and ran sensitivity analyses according to his suggestion. First, we did not include the Clinical Global Impression scale,2 because we found that CIBIC-plus (Clinical Interview-based of Change plus Carer Interview)3 was the commonest tool used in our included studies. We did not include the Neuropsychiatric Inventory score (NPI) in the study by Araki et al,4 becausewe found the change of NPI was abnormally high in the control group (ie, 23.88). Furthermore, Dr Matsunaga suggested reversing the algebraic sign of the outcomes, but we actually put the reverse interpretation for the values on the NPI and CIBIC-plus with reference to the MiniMental State Examination (MMSE) and Alzheimer’s Disease Cooperative StudyeActivities of Daily Living. In the forest plots, the labels of interpretation were clearly shown in the horizontal axis. As a result, our results do not have the data errors as mentioned. Second, we knew that studies by Doody et al,5 Farlow et al,6 and Sadowsky et al7 were based on post hoc analyses. Therefore, we included only the last publication of the same cohort of patients. We also noted that the team of Farlow et al6 reported 2 independent studies6,8 for different levels of Alzheimer disease. The study of Howard et al9 had 2 placebo groups to compare the 2 types of combination therapy. The participants in the placebo groups were not the same. Therefore, we had already avoided the problem of multiple comparisons. Third, we understand that the analysis may be mixed up with the results from intention-to-treat (ITT) and observed case (OC) approaches, but not all the studies clearly reported this classification. We identified 3 studies that reported both results from ITT and OC approaches,10e12 and subgroup analyses were performed. Combination therapy still showed no benefit on any domain. For example, mean difference (95% confidence interval) of MMSE are 0.13 ( 0.39 to 0.65) in ITT and 0.20 ( 0.34 to 0.73) in OC.