This cross-sectional study was conducted parallel to a study evaluating the Q mci screen in an Irish memory clinic population and the methods have been reported elsewhere. Given these points, this study aims to compare the diagnostic accuracy for cognitive impairment of the 6CIT against two other short CSIs, the Quick Mild Cognitive Impairment (Q mci) screen, and Montreal Cognitive Assessment (MoCA). A recent systematic review in 2018 suggests that additional robust validation studies are needed, comparing the 6CIT to a wide range of short cognitive assessments. Further, few studies have compared the 6CIT to other short screens and none to those useful in identifying early cognitive decline. A recent validation in a memory clinic population showed a sensitivity of 88% for dementia and 66% for MCI when compared to the Mini-Mental State Examination (MMSE). There are, however, relatively few studies examining its performance in outpatient (secondary care) settings and especially in persons with MCI, before the onset of functional decline and in those with subjective cognitive decline (SCD), where individuals are symptomatic but do not have evidence of cognitive impairment on testing. The Six-Item Cognitive Impairment Test (6CIT), is a commonly-used short cognitive screening instrument (CSI) and is reported to have high diagnostic accuracy for dementia in an older hospital population (90% sensitivity and 96% specificity at a cut-off of ≥8/28 for dementia). These are also influenced by the well-documented time-accuracy trade off such that short screens tend to lower levels of diagnostic accuracy. While a wide variety of performance-based instruments are available, they vary in their administration times, cognitive domains assessed and ability to differentiate between normal cognition, mild cognitive impairment (MCI), and dementia, though it is suggested that no single instrument will likely suit all situations. Screening of symptomatic patients is further limited by a lack of suitably sensitive and specific instruments. Guidelines and recommendations support the need to provide diagnostic services close to patients in the community, but several structural barriers exist aggravated by staff shortages and inadequate training. The prevalence of cognitive impairment (CI) including dementia is expected to increase worldwide to over 150 million people by 2050, generating additional workload in already busy primary and secondary care (outpatient) clinics, as systems work towards better and earlier diagnosis.
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