Subtle cognitive decline (SCD) may represent a very early stage of objective cognitive impairment before mild cognitive impairment (MCI), with less neuronal damage and more functional reservation. Detecting individuals with SCD is imperative for dementia prevention and treatment. In this study, we aimed to compare the validations of three cognitive screening tests, Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment-Chinese Version (MoCA-CV), and Memory and Executive Screening (MES), in identifying subtle cognitive decline. A total of 407 individuals were recruited, including 147 cognitively normal controls (NC), 102 individuals with subtle cognitive decline (SCD) and 158 individuals with mild cognitive impairment (MCI) according to the operational neuropsychological criteria proposed by Jak and Bondi’s. All participants underwent standardized comprehensive neuropsychological tests and the three cognitive screening tests. Chi-square analysis was used to compare the cognitive performance among the groups of NC, SCD and MCI. Receiver operating characteristic (ROC) curves were used to evaluate the abilities of MMSE, MoCA-CV and MES in discriminating NC, SCD and MCI. Compared with NC, SCD showed a significant decline only in the tests of memory, such as Auditory Verbal Learning Test (AVLT), Rey-Osterrieth Complex Figure Test (CFT) and Prospective Memory Test (PrM) (P < 0.01). However, MCI showed significant decline in all cognitive performances (P < 0.01). The scores of MMSE, MoCA-CV and MES all showed a progressive downward trend within the groups of NC, SCD and MCI (P < 0.001). In ROC Analyses for discriminating individuals with SCD from NC, the most appropriate MES cutoff was 84, with a sensitivity of 74.3%, a specificity of 60.8% and 0.738 for AUC (95%CI, 0.675–0.801). By contrast, MMSE and MOCA-CV had poor sensitivity (67.4 and 70.8%, respectively) and specificity (51.0 and 52.9%, respectively), and smaller AUCs (0.643 and 0.644, respectively) than the MES. As a screening test, MES is more efficacious in identifying SCD from normal controls than MMSE and MoCA-CV.

中文翻译：

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三种认知筛选测试在识别微妙的认知下降中的有效性的比较研究。

微妙的认知功能减退（SCD）可能代表了客观认知障碍的早期，而轻度认知障碍（MCI）之前的神经元损害较少且功能保留更多。检测患有SCD的个体对于痴呆症的预防和治疗势在必行。在这项研究中，我们旨在比较三种认知筛查测试（微型精神状态考试（MMSE），蒙特利尔认知评估中文版（MoCA-CV）和记忆与执行筛查（MES））的有效性，以识别微妙的认知下降。根据Jak和Bondi's提出的操作性神经心理学标准，共招募了407名个体，包括147名认知正常对照（NC），102名有轻微认知下降（SCD）的人和158名有轻度认知障碍（MCI）的人。所有参与者均接受了标准化的全面神经心理学测试和三种认知筛查测试。卡方分析用于比较NC，SCD和MCI组之间的​​认知表现。接收器工作特性（ROC）曲线用于评估MMSE，MoCA-CV和MES区分NC，SCD和MCI的能力。与NC相比，SCD仅在听觉语言学习测验（AVLT），Rey-Osterrieth复杂图形测验（CFT）和前瞻性记忆测验（PrM）等记忆测试中显示出显着下降（P <0.01）。但是，MCI的所有认知表现均显着下降（P <0.01）。在NC，SCD和MCI组中，MMSE，MoCA-CV和MES的得分均呈下降趋势（P <0.001）。在ROC分析中，将SCD患者与NC患者区分开来，最合适的MES截止值为84，灵敏度为74.3％，对AUC的特异性为60.8％和0.738（95％CI，0.675-0.801）。相比之下，与MES相比，MMSE和MOCA-CV的敏感性（分别为67.4和70.8％）和特异性（分别为51.0和52.9％）差，并且AUC较小（分别为0.643和0.644）。作为筛查测试，MES在识别正常对照中的SCD方面比MMSE和MoCA-CV更有效。