Screening for dementia—a comparison of two tests using receiver operating characteristic (ROC) analysis

The abilities of the Mini‐Mental State Examination (MMSE) and the Information/Orientation (IO) subtest of the CAPE assessment to detect a range of severities of dementia were compared by receiver operating characteristic (ROC) analysis. One thousand five hundred and seventy‐nine persons completed the initial screening phase and on the basis of their MMSE score, 438 completed the second stage, a full psychiatric assessment using the CAMDEX (Cambridge Mental Disorders of the Elderly Examination). The IO subtest performed significantly better than the MMSE for detection of moderate and severe dementia. However, for minimal or worse dementia the MMSE showed the best overall performance. Optimal cutpoints for detection of moderate+ dementia were found to be 18/19 (MMSE) and 8/9 (IO subtest) while for mild and more severe dementia these were 22/23 (MMSE) and 11/12 (IO subtest). For both screens the ability of the test to discriminate dementia was significantly impaired for those with physical disability, of manual social class or low educational attainment. The MMSE also performed worse with those aged 80 years and over.