These modules are available by licensing them from Dr. Sheehan, please see the license information below. The standard MINI Kid assesses the 30 most common and clinically relevant disorders or disorder subtypes in pediatric mental health. The standard version of the MINI Kid meets most needs, most of the time in both clinical and research settings.
The non-standard versions are mainly for use in settings where more detail is needed for some disorders, that are not captured in the standard version or when input from the parent or guardian is required. We recommend using the standard child version. With this version the child and parent are interviewed together. The question is directed to the child. The parent is asked to remain silent and not to respond unless the parent believes it is clear that the child has provided inaccurate information.
In this event the clinician then triangulates the discussion between child, parent and clinician, to get the most accurate assessment, and records the responses accordingly. Using the parent version is not usually necessary, nor is it time and cost efficient most of the time.
But this decision needs to be made by the on-site clinician to meet the needs of each family. Like the adult MINI, it uses branching tree logic in the interest of brevity. The f low chart click here helps guide you in choosing which version of the MINI Kid is more likely to meet your needs.
A negative response to the screening questions usually means it is unlikely the patient has the disorder. It is suitable for clinical and research settings where Tobacco Use disorder is a focus of interest. It has more detailed modules on each of the Suicidality Disorder phenotypes beyond the questions assessing overall suicidality in the standard MINI Kid. This permits one stop shopping in having one instrument MINI Kid Tracking to both assess and quantitatively monitor the response to treatment.
The amount is payable in full before study initiation. For information about training on the MINI, via Zoom or in person, for large groups or investigators meetings please contact: davidvsheehan gmail. For information about virtual web-based training module on the MINI — which include a video, a quiz, and a certificate of completion of training:. Adult MINI 7. MINI Kid 7. Sheehan does not authorize anyone to provide training on the MINI or on his scales who is not a licensed psychiatrist or clinical psychologist MD or PhD and who has not been specifically trained and authorized to provide this training by Dr.
Information on how to contact Mapi for translations will be supplied after you have obtained a fully executed license agreement signed by Dr. Sheehan granting you permission to use the MINI.
Clin Psychiatry, ;59 suppl 20 : European Psychiatry. Concordance and causes for discordance with the CIDI. J Clin Psychiatry; ;71 3 Home About Us David V. Giddens Scales. Privacy Statement. Science of Suicidality SOS.
Cart Checkout. All Rights Reserved. Advertica Theme by SketchThemes. The main results are summarized below Figure 2 ; Figure 3. Risk of bias and applicability concerns graph: review authors' judgements about each domain presented as percentages across included studies. Risk of bias and applicability concerns summary: review authors' judgements about each domain for each included study. We considered four studies Buchhave ; Chopard ; Modrego ; Palmqvist to be at unclear risk of bias because they did not report whether the participants were systematically enrolled.
We considered the remaining four studies Devanand ; Modrego ; Pozueta ; Xu to be at low risk of bias. Some studies reported poorly which MMSE version was used and who administered and interpreted the test. In the flow and timing domain we considered the majority of studies eight to be at low risk of bias. For assessment of applicability concerns, for the majority of the studies seven there was no concern that the included patients and setting, the conduct and interpretation of the index test, and the target condition as defined by the reference standard did not match the review question.
We judged that there was unclear concern about applicability for Modrego regarding all three domains and for Buchhave , Modrego and Pozueta regarding the reference standard domain.
It should be noted that the lack of concern about applicability of the three domains mentioned above was based on the inclusion criteria set in the review. Included studies are detailed in Characteristics of included studies and Table 2 and Table 3.
Another reference had a single population followed in two different time frames and thresholds Modrego Finally, one of the studies showed information about the accuracy of the Orientation and Recall MMSE subscales Palmqvist but this information was not included in our analysis. In all studies, between One additional study provided accuracy for a predicted risk of 0.
Only one study provided data for vascular dementia VaD incidence Xu , 6. The scope of the studies included data from five different countries: four studies from Spain; two from Japan, Switzerland and USA; and one from France. Under these conditions, there was considerable uncertainty regarding the combination of results from these studies, and the pooled results derived from this model need to be interpreted with caution.
The degree of heterogeneity as well as the quality of evidence lowers the level of confidence in the strength of the results. In a hypothetical cohort of MCI patients with a The degree of heterogeneity as well as the quality of evidence lowered our confidence in the strength of the results. In a hypothetical cohort of MCI patients the number of missed cases would be 5 patients, and 19 MCI patients would be overdiagnosed. In a narrative description, we noticed that the index test threshold was one of the main sources of variability between included studies.
We also noticed an important variability in the estimated incidence of dementia. We removed the data of Modrego and Modrego because these studies used a MMSE version with a different scale 35 points. We did not find a significant difference in test accuracy or in perception of heterogeneity when these studies were removed. See 'Characteristics of included studies' for more detailed study descriptors. In this review we included 11 heterogeneous studies with a total number of MCI patients followed for conversion to dementia.
Other dementias, such as frontotemporal dementia or Lewy body dementia, were not assessed by any study. Two out of four included studies used CDR scores of 0. According to this information, MMSE scores appear to have a modest specificity but without the capacity to detect more than half of the MCI converters.
Five out of eight included studies used the Petersen diagnostic criteria Petersen ; Petersen for defining MCI. Our review is part of a series of diagnostic test accuracy DTA reviews related to neuropsychological tests on dementia, for which a generic protocol was developed.
This protocol identified a priori the best methodology in order to assess the accuracy of cognitive tests in the identification or conversion to any type of dementia Davis We were challenged in the selection of studies for the research question because we shared a search strategy designed to cover all the DTA reviews related to MMSE and its accuracy in different settings that is in people over 65 years within a secondary healthcare setting, and asymptomatic and previously clinically unevaluated people aged over 65 years in community and primary care populations.
At the same time, with the use of such an exhaustive search strategy we could be sure we included all possible studies, even those with smaller sample sizes, to determine the accuracy of MMSE in predicting conversion from MCI to full dementia. Although the MMSE is a cognitive test with more than 40 years of use, we only identified studies published since to answer our research question, possibly due to our specific baseline population MCI.
Such a combination of inclusion criteria had a direct influence on the number of retrieved and included studies in our review. For instance, a considerable number of studies with potential information were excluded because MMSE scores were evaluated as a part of prediction models without providing information about the accuracy of a specified threshold. We hope that in the future we can update our review with information provided by the contacted authors of excluded studies as well as ongoing studies.
We noticed that most of the included studies did not have the assessment of baseline MMSE scores as a main purpose. In most studies the MMSE was included as part of the usual diagnostic pathway for MCI patients and a common comparator for the principal test assessed.
This directly affected the reporting quality and, most importantly, the methodological evaluation of included studies. The scarcity of information did not allow us to formally assess the influence of this factor in the accuracy of MMSE, but the differences are easily noticed in the analysis of SROC curves. Although the MMSE is a test with quick and easy administration, needs few resources and covers multiple cognitive domains at once, it is necessary to remark that this test was not developed to identify the early stages of dementia or even to predict the development of dementia in the long term.
These results may show that the items of the MMSE are insufficient to detect the change from mild to advanced cognitive decline, or even that some factors such as age, education and literacy must be taken into account to determine its true value in MCI patients. Likewise, this brief cognitive test may be more useful to document cognitive changes over time rather than to predict future progression with a single measurement. The verification of this hypothesis requires the assessment of evidence not presented in this review.
At present, there is consensus about the clinical relevance of MCI because this stage represents an opportunity to prevent or delay progression to dementia through modifications of risk factors such as depression and hypertension. The identification of diagnostic tools to predict which patients may progress to more severe stages of the disease has become a priority.
The role of cognitive tests in the diagnosis of dementia is not questioned,because they show the clinical decline in areas like speed of information processing, executive functions and reasoning Sperling , while the role of biomarkers remains under evaluation Kokkinou ; Ritchie ; Vacante ; Zhang MMSE advantages reside in the easy way of administration especially in terms of time and resources without direct harmful effects, as well as a high acceptability by the health professionals involved in the management of people with dementia.
In fact this popular test is frequently administered by clinicians to MCI patients and our review could help them to interpret the results of MMSE of their patients.
Ideally, this brief cognitive test could be used for initial classification of MCI patients in order to determine their needs in a further and comprehensive assessment. However, there might be occasions where an extensive and formal neuropsychological evaluation is not available. In both cases it is important that clinicians know the limitations related to the use of this test in the prediction of dementia for MCI patients. In the case of progression to dementia in general we found similar results.
In all cases, clinicians would prefer to request additional and extensive tests to be sure about the management of these patients. We think that MMSE items, despite the fact that they cover several cognitive domains, are insufficient for registering subtle cognition changes in MCI patients, especially for detecting those dementias without an important decline in the memory domain such as frontotemporal dementia and primary progressive apraxia.
At present, the identification of useful cognitive tests that are able to detect subtle cognitive changes in people at different stages of dementia has become an important challenge. Although the information included in this review does not support the extended use of the MMSE in the stage of progression of MCI to dementia, we should not forget that this kind of test could be useful in settings where formal neuropsychological assessment is not available.
Likewise, it is essential to know if there are subsets of MMSE items which could be more strongly associated with progression to dementia. If such a subset of items exists, clinicians will be confident that those results denote conversion to a particular kind of dementia for instance, conversion to ADD determined by the memory items of the MMSE. An important aspect to consider in future updates is if conversion to dementia from MCI stages could be predicted better by MMSE changes over time instead of isolated measurements.
The role of repeated measurements of MMSE might be more informative than baseline scores, but a formal evaluation of the utility of numerical differences between serial MMSEs has not been performed yet. Finally, although the alternative of a single indicator for progression to dementia is attractive, it would be more interesting to assess if a set of tests, rather than an isolated one, may be more successful in predicting conversion from MCI to dementia.
A diagnostic model composed of different cognitive and biomarker tools could be more useful for this condition.
Presented below are all the data for all of the tests entered into the review. Method of MMSE administration, including who administered and interpreted the test and their training. Method of reference standard administration, including who administered the test and their training. Settings: i community; ii primary care; iii secondary care outpatients; iv secondary care inpatients and residential care.
We provide some core anchoring statements for quality assessment of diagnostic test accuracy of MMSE. If a question is answered 'no', this indicates risk of potential bias. The focus group was tasked with judging the extent of the bias for each domain. During this process, it became clear that certain issues were key to assessing quality, whilst others were important to record but were less important for assessing overall quality. To assist, we describe a 'weighting' system.
For example, in dementia, diagnostic test accuracy studies, ensuring that clinicians performing dementia assessment are blinded to results of the index test, are fundamental. If this blinding was not present, then the item on the reference standard should be scored 'high risk of bias', regardless of the other contributory elements.
In assessing individual items, the score of "unclear" should be given only if there is genuine uncertainty. In these situations, review authors will contact the relevant study teams for additional information.
Was a consecutive or random sample of patients enrolled? Weighting: high risk of bias no. Did the study avoid inappropriate exclusions? The study will be automatically graded as unclear if exclusions are not detailed pending contact with study authors.
For a community sample, we would expect relatively few exclusions. Included patients should match the intended population as described in the review question. If not already specified in the review inclusion criteria, the setting will be particularly important—the review authors should consider population in terms of symptoms, pretesting and potential disease prevalence.
Studies that use very selected participants or subgroups will be classified as having low applicability, unless they are intended to represent a defined target population, for example, people with memory problems referred to a specialist and investigated by lumbar puncture.
Were MMSE results interpreted without knowledge of the reference standard? Weighting: high risk no. Were MMSE thresholds prespecified? Different thresholds are used in different populations. Some papers use an alternative methodology for analysis that does not use thresholds; these papers should be classified as not applicable. Were sufficient data on MMSE application given for the test to be repeated in an independent study?
Particular points of interest include method of administration e. If a novel form of the index test is used, for example, a translated questionnaire, details of the scale should be included and a reference given to an appropriate descriptive text; evidence of validation should be provided.
Is the assessment used for clinical diagnosis of dementia acceptable? Was clinical assessment for dementia performed without knowledge of the MMSE results? Some methods of dementia assessment, although valid, may diagnose a far smaller or larger proportion of individuals with the disease than in usual clinical practise. For example, currently the reference standard for vascular dementia may underdiagnose compared with usual clinical practise.
In this instance, the item should be rated as having poor applicability. Was there an appropriate interval between MMSE and the reference standard? As we test the accuracy of the MMSE test for MCI conversion to dementia, a delay will always be noted between the index test and the reference standard assessments.
The time between reference standard and index test will influence the accuracy, and therefore we will note time as a separate variable both within and between studies and will test its influence on diagnostic accuracy. Did all participants receive the same reference standard? When dementia assessment or reference standard differs between participants, this should be classified as high risk of bias.
Were all participants included in the final analysis? Other characteristics e. AG: designed and drafted protocol; set up data and analysis tables; drafted Results and Discussion sections and finalised manuscript.
OLP: designed and drafted protocol; study selection and data extraction; drafted Results and Discussion sections and finalised manuscript.
XBC: designed and drafted protocol; drafted Results and Discussion sections and finalised manuscript. SC: designed and drafted protocol; drafted Results and Discussion sections and finalised manuscript. National Center for Biotechnology Information , U. Cochrane Database Syst Rev. Published online Mar 5. Author information Copyright and License information Disclaimer.
Corresponding author. This article has been updated. This article is an update of with doi: This article has been cited by other articles in PMC. Abstract Background Dementia is a progressive global cognitive impairment syndrome. Data collection and analysis We screened all titles generated by the electronic database searches. Main results In this review, we included 11 heterogeneous studies with a total number of MCI patients followed for conversion to dementia.
Background Dementia is a progressive global cognitive impairment syndrome. Target condition being diagnosed In general, dementia as diagnosed is defined by a deficit in more than two cognitive domains that is of sufficient degree to impair functional activities. Clinical pathway Dementia develops over a trajectory of several years.
Prior test s Most tests for example neuroimaging, CSF analysis are usually performed after a cognitive deficit has been identified. Role of index test s Accurate diagnosis leads to opportunities for treatment. Rationale The public health burden of cognitive and functional impairment due to dementia is of growing concern.
Secondary objectives To assess the heterogeneity of test accuracy by population for example memory clinics, community settings and MMSE thresholds, amongst other factors. Participants We included participants recruited from community, primary care and secondary care settings and clinically classified as individuals with MCI at baseline.
Reference standards Currently, no in vivo gold standard is used for the diagnosis of dementia, and even the value of diagnoses based on neuropathological criteria has been questioned Scheltens Searching other resources We checked the reference lists of all relevant papers for additional studies. Data collection and analysis Selection of studies We selected studies on the basis of title and abstract screening undertaken by the review authors or by teams of experienced assessors.
Investigations of heterogeneity In preliminary analyses, we visually examined forest plots of sensitivity and specificity and summary ROC SROC plots to explore the effect of the sources of heterogeneity. Assessment of reporting bias Quantitative methods for exploring reporting bias are not well established for studies of DTA.
Results Results of the search Our search resulted in 24, citations 47 identified in congress reports , of which 17, references that were not related to MMSE information were excluded Figure 1. Open in a separate window. Figure 1. Figure 2. Figure 3. Findings Included studies are detailed in Characteristics of included studies and Table 2 and Table 3. Figure 4. Figure 5. Figure 6. Figure 7. Summary of findings Summary of findings 1 Summary of findings table.
Summary estimates of sensitivity and specificity were not computed due to high heterogeneity derived from included studies. Summary of findings 2 Table of descriptive data.
Discussion Summary of main results In this review we included 11 heterogeneous studies with a total number of MCI patients followed for conversion to dementia. Strengths and weaknesses of the review Our review is part of a series of diagnostic test accuracy DTA reviews related to neuropsychological tests on dementia, for which a generic protocol was developed.
Applicability of findings to the review question Although the MMSE is a test with quick and easy administration, needs few resources and covers multiple cognitive domains at once, it is necessary to remark that this test was not developed to identify the early stages of dementia or even to predict the development of dementia in the long term.
Authors' conclusions At present, there is consensus about the clinical relevance of MCI because this stage represents an opportunity to prevent or delay progression to dementia through modifications of risk factors such as depression and hypertension. Data Presented below are all the data for all of the tests entered into the review. Tests Data tables by test. Test No. Test 1. Test 2. Test 3. Appendices Appendix 1. Search strategies Source Search strategy 1.
CDR adj2 "0. Appendix 2. Information for extraction to proforma Bibliographic details of primary paper. Author, title of study, year and journal. Details of index test. Thresholds used to define positive and negative tests.
Reference standard. Reference standard used. Study population. Number of participants. APOE status. Participant recruitment. Sampling procedures. Time between index test and reference standard. Proportion of people in sample with dementia. Subtype and stage of dementia if available. MCI definition used if applicable. Attrition and missing data. Appendix 3. Were the index test results interpreted without knowledge of results of the reference standard?
If a threshold was used, was it prespecified? Is the reference standard likely to correctly classify the target condition? Were the reference standard results interpreted without knowledge of results of the index test?
Did all participants receive a reference standard? Were all participants included in the analysis? Risk of bias high, low, unclear Could the selection of participants have introduced bias? Could the conduct or interpretation of the index test have introduced bias? Could the reference standard, its conduct or its interpretation have introduced bias?
Could the participant flow have introduced bias? Concerns regarding applicability high, low, unclear Are there concerns that included participants do not match the review question?
Are there concerns that the index test, its conduct or its interpretation differs from the review question? Are there concerns that the target condition as defined by the reference standard does not match the review question? Appendix 4. Anchoring statements for quality assessment of MMSE diagnostic studies We provide some core anchoring statements for quality assessment of diagnostic test accuracy of MMSE. Anchoring statements to assist with assessment for risk of bias Domain 1: patient selection Risk of bias: could the selection of patients have introduced bias?
Weighting: high risk of bias no Did the study avoid inappropriate exclusions? Applicability: are there concerns that included patients do not match the review question? Domain 2: index test Risk of bias: could the conduct or interpretation of the index test have introduced bias?
Weighting: high risk no Were sufficient data on MMSE application given for the test to be repeated in an independent study? Applicability: are there concerns that the index test, its conduct or its interpretation may differ from the review question?
Domain 3: reference standard Risk of bias: could the reference standard, its conduct or its interpretation have introduced bias?
Weighting: high risk no Was clinical assessment for dementia performed without knowledge of the MMSE results? Applicability: are there concerns that the target condition as defined by the reference standard does not match the review question? Domain 4: participant flow and timing note refer to, or construct, a flow diagram Risk of bias: could the participant flow have introduced bias?
Weighting: high risk no Did all participants receive the same reference standard? Weighting: high risk no Were all participants included in the final analysis? Notes New. Differences between protocol and review 1. Index test Thresholds Technical features including different versions of the test Operator characteristics e. Characteristics of studies Characteristics of included studies [ordered by study ID] Buchhave Study characteristics Patient sampling MCI patients who performed the cube copying test were recruited from a memory clinic in a prospective manner.
Sampling procedure is not fully described mostly referred by general practitioners. Exclusion criteria involves: patients with other causes of cognitive impairment, including brain tumour, subdural haematoma, CNS infection, major depressive episode, schizophrenia and current alcohol abuse Patient characteristics and setting This study included MCI participants who performed the cube copying test and were diagnosed by the Petersen criteria at baseline.
Physicians specialised in cognitive disorders performed a thorough physical, neurological and psychiatric examination, as well as a clinical interview, of each patient at baseline. The remaining MCI subjects were referred by other physicians Yes Did the study avoid inappropriate exclusions? Yes Did all participants receive the same reference standard? Yes Were all participants included in the final analysis? In addition, no details about recruitment of MCI patients were reported Exclusion criteria: not reported Patient characteristics and setting A total of participants with MCI, diagnosed with the Portet criteria , were recruited from the Memory and Dementia Assessment Unit.
The test was administered by a team of neuropsychologist from the hospital unit. No details about who interpreted the test. Study characteristics Patient sampling A total of outpatients with memory complaints MCI broadly defined from a Memory Disorders Clinic were consecutive recruited Exclusion criteria: not reported Patient characteristics and setting A total of patients were included in analysis.
It is unclear who administered the baseline test. Two expert raters reviewed the neuropsychological information to determine inclusion No threshold was used. Quote: "Based on the fitted logistic regression and dichotomizing estimated risk at 0. Study characteristics Patient sampling This reference have two incidence studies called Meguro a and Meguro b for this review.
Those participants were recruited from the same community based population. Study characteristics Patient sampling Cohort of 59 consecutive amnestic MCI patients referred from the community by family physicians for recent memory complaints Exclusion criteria: not detailed Patient characteristics and setting A total of 59 consecutive patients with memory complaints and criteria for MCI were recruited from a outpatient clinic. The authors asked the general practitioners to refer to them all elderly patients with memory complaints and then they included all who fulfilled the criteria for amnestic mild cognitive impairment Petersen The final diagnosis was made by taking into account as much information as possible from all sources.
Baseline demographic data are reported inside the text Page and in the table 1: Gender: 34 F, 21 M Age: MMSE at baseline: No details about who administered and interpreted the test. Unclear Were all participants included in the final analysis? No details about who administered and interpreted the test at baseline.
Palmqvist Most patients were referred from primary care units, but some referrals came from other clinics at the hospital. No further details about recruitment were reported Exclusion criteria: patients with diagnosis of haematoma, brain tumour, CNS infection, schizophrenia, major depressive episode or current alcohol abuse were not included Patient characteristics and setting A total of participants with MCI, diagnosed with the Petersen criteria, were recruited in the memory clinic.
The test was administered by physicians experienced in dementia disorders. Unclear who administered and interpreted the test. At the time to publish this review, we did not had enough information to include this study Luck MMSE is included in a Cox proportional hazard model; no data about accuracy are provided Madureira MMSE is included in a logistic regression model Mauri We made request to authors to obtain useable data, but we did not receive response.
Characteristics of ongoing studies [ordered by study ID] Hall Iberoamerican Cochrane Centre, Barcelona, Spain. Declarations of interest None known.
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