Characteristics of a two-stage screen for incident dementia

Kathleen M. Hayden, Ara S. Khachaturian, Jo Ann T. Tschanz, Chris Corcoran, Maria Nortond, John C.S. Breitner

Research output: Contribution to journalArticle


Background and Objectives: To avoid costly evaluation of healthy individuals, efficient methods of screening for incident dementia must combine adequate sensitivity and high specificity. Two-stage screening may offer improvements over single-stage methods. We therefore investigated a two-stage screening protocol for incident dementia among 3,308 elderly. Methods: We administered the Modified Mini-Mental-State (3MS) or, rarely, Jorm's IQCODE, to a validation sample of 441 high-risk respondents. Informants then completed the Dementia Questionnaire (DQ). Finally, all 441 sample members underwent physical, neurologic, and neuropsychologic assessment. We studied the sensitivity and specificity of the 3MS/IQCODE and DQ using Receiver-Operating Characteristic analyses. Results: A 3MS cut point of 82/83 (of 100) yielded sensitivity and specificity of 91.5 and 90.1%. With 3MS scores of ≤82, a DQ cut point of 2/3 (of five) yielded conditional sensitivity and specificity of 90.2 and 55.3%. Combining these instruments yielded sensitivity and specificity of 82.5 and 95.6%. Age stratification and use of longitudinal decline score criteria did not materially improve these figures. Conclusions: The improved specificity of the two-stage approach offers economies that are attractive, particularly if sensitivity can be enhanced, for example, by examination of a high-risk validation sample.

Original languageEnglish (US)
Pages (from-to)1038-1045
Number of pages8
JournalJournal of Clinical Epidemiology
Issue number11
StatePublished - Nov 2003



  • Dementia
  • Mass screening
  • Receiver-operating characteristic analysis
  • Sensitivity
  • Specificity
  • Validation sample

ASJC Scopus subject areas

  • Epidemiology

Cite this

Hayden, K. M., Khachaturian, A. S., Tschanz, J. A. T., Corcoran, C., Nortond, M., & Breitner, J. C. S. (2003). Characteristics of a two-stage screen for incident dementia. Journal of Clinical Epidemiology, 56(11), 1038-1045.