Communicating Risk: Developing an “Efficiency Index” for Dementia Screening Tests
Abstract
:1. Introduction
Sensitivity (Sens) = TP/(TP + FN) Specificity (Spec) = TN/(FP + TN) Positive predictive value (PPV) = TP/(TP + FP) Negative predictive value (NPV) = TN/(FN + TN) Positive likelihood ratio (LR+) = TP/(TP + FN)/FP/(FP + TN) Negative likelihood ratio (LR−) = FN/(TP + FN)/TN/(FP + TN) Accuracy (Acc) = (TP + TN)/(TP + FP + FN + TN) Inaccuracy (Inacc) = (FP + FN)/(TP + FP + FN + TN) |
2. Methods
3. Results
4. Discussion
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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CSI | N | P = Prevalence of Dementia = (TP + FN)/N | Age, Median (years) | Gender (F:M; %F) | Test Threshold for Dementia | Ref(s) |
---|---|---|---|---|---|---|
MMSE | 244 | 0.18 | 60 | 117:127; 48 | <26/30 | [23,24] |
MoCA | 260 | 0.17 | 59 | 118:142; 45 | <26/30 | [25] |
MACE | 755 | 0.15 | 60 | 352:403; 47 | ≤20/30 | [26] |
Free-Cog | 141 | 0.11 | 62 | 61:80; 43 | ≤22/30 | [27] |
CSI | Acc | Inacc | Y (=Sens + Spec − 1) | LDM (=NNM/NND) | II (=2.Acc − 1) | EI (=Acc/Inacc) |
---|---|---|---|---|---|---|
MMSE | 0.676 | 0.324 | 0.497 | 1.536 | 0.352 | 2.089 |
MoCA | 0.427 | 0.573 | 0.313 | 0.547 | −0.146 | 0.745 |
MACE | 0.738 | 0.262 | 0.619 | 2.360 | 0.475 | 2.817 |
Free-Cog | 0.709 | 0.291 | 0.670 | 2.320 | 0.418 | 2.439 |
Cut-Off | Acc | Inacc | Y | LDM | II | EI |
---|---|---|---|---|---|---|
≤29/30 | 0.170 | 0.830 | 0.02 | 0.02 | −0.66 | 0.204 |
≤28/30 | 0.197 | 0.803 | 0.05 | 0.06 | −0.61 | 0.246 |
≤27/30 | 0.262 | 0.738 | 0.12 | 0.16 | −0.48 | 0.355 |
≤26/30 | 0.336 | 0.664 | 0.21 | 0.33 | −0.33 | 0.507 |
≤25/30 | 0.417 | 0.583 | 0.31 | 0.53 | −0.17 | 0.716 |
≤24/30 | 0.495 | 0.505 | 0.39 | 0.76 | −0.01 | 0.982 |
≤23/30 | 0.560 | 0.440 | 0.47 | 1.07 | 0.12 | 1.27 |
≤22/30 | 0.625 | 0.375 | 0.53 | 1.43 | 0.25 | 1.67 |
≤21/30 | 0.687 | 0.313 | 0.59 | 1.90 | 0.37 | 2.20 |
≤20/30 | 0.738 | 0.262 | 0.62 | 2.36 | 0.48 | 2.82 |
≤19/30 | 0.771 | 0.229 | 0.61 | 2.67 | 0.54 | 3.36 |
≤18/30 | 0.801 | 0.199 | 0.60 | 3.00 | 0.60 | 4.03 |
≤17/30 | 0.808 | 0.192 | 0.56 | 2.95 | 0.62 | 4.21 |
≤16/30 | 0.841 | 0.159 | 0.58 | 3.63 | 0.68 | 5.29 |
≤15/30 | 0.860 | 0.140 | 0.56 | 4.00 | 0.72 | 6.12 |
≤14/30 | 0.868 | 0.132 | 0.51 | 3.92 | 0.74 | 6.55 |
≤13/30 | 0.866 | 0.134 | 0.41 | 3.15 | 0.73 | 6.48 |
≤12/30 | 0.866 | 0.134 | 0.37 | 2.79 | 0.73 | 6.48 |
P, P′ | Acc | Inacc | LDM (=NNM/NND =Y/Inacc) | EI (=NNM/NND* =Acc/Inacc) |
---|---|---|---|---|
0.1, 0.9 | 0.728 | 0.272 | 2.70 | 2.68 |
0.2, 0.8 | 0.748 | 0.252 | 2.45 | 2.97 |
0.3, 0.7 | 0.768 | 0.232 | 2.67 | 3.33 |
0.4, 0.6 | 0.789 | 0.211 | 2.93 | 3.74 |
0.5, 0.5 | 0.809 | 0.191 | 3.25 | 4.24 |
0.6, 0.4 | 0.830 | 0.170 | 3.64 | 4.88 |
0.7, 0.3 | 0.851 | 0.149 | 4.14 | 5.71 |
0.8, 0.2 | 0.871 | 0.129 | 4.80 | 6.75 |
0.9, 0.1 | 0.892 | 0.108 | 5.72 | 8.26 |
EI | % Change in Diagnostic Probability Calculated Independent of Pre-Test Probability as 0.19 × loge(EI) | MACE: % Change in Diagnostic Probability Based on Pre-Test Probability (0.15) [26] | MoCA: % Change in Diagnostic Probability Based on Pre-Test Probability (0.17) [25] | TYM: % Change in Diagnostic Probability Based on Pre-Test Probability (0.35) [31] |
---|---|---|---|---|
10.0 | +43.7 | +49 | +54 | +49 |
5.0 | +30.5 | +32 | +34 | +38 |
4.882 (TYM) | +30.1 | - | - | +37 |
2.817 (MACE) | +19.7 | +18 | - | - |
2.0 | +13.2 | +11 | +12 | +17 |
1.0 | 0 | 0 | 0 | 0 |
0.745 (MoCA) | −5.6 | - | −4 | - |
0.5 | −13.2 | −7 | −8 | −14 |
0.2 | −30.5 | −12 | −13 | −25 |
0.1 | −43.7 | −13 | −15 | −30 |
EI Value | Qualitative Classification of Change in Probability of Diagnosis (after Jaeschke et al. [14]) | Approximate % Change in Probability of Diagnosis (after McGee [21]) |
---|---|---|
≤0.1 | Very large decrease | - |
0.1 | Large decrease | –45 |
0.2 | Large decrease | –30 |
0.5 | Moderate decrease | –15 |
1.0 | 0 | |
2.0 | Moderate increase | +15 |
5.0 | Moderate increase | +30 |
10.0 | Large increase | +45 |
≥10.0 | Very large increase | - |
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Larner, A.J. Communicating Risk: Developing an “Efficiency Index” for Dementia Screening Tests. Brain Sci. 2021, 11, 1473. https://doi.org/10.3390/brainsci11111473
Larner AJ. Communicating Risk: Developing an “Efficiency Index” for Dementia Screening Tests. Brain Sciences. 2021; 11(11):1473. https://doi.org/10.3390/brainsci11111473
Chicago/Turabian StyleLarner, Andrew J. 2021. "Communicating Risk: Developing an “Efficiency Index” for Dementia Screening Tests" Brain Sciences 11, no. 11: 1473. https://doi.org/10.3390/brainsci11111473