OTSLPOtherJournal of applied research in intellectual disabilities : JARID2021

Evaluation of the National Task Group-Early Detection Screen for Dementia: Sensitivity to 'mild cognitive impairment' in adults with Down syndrome.

Wayne Silverman, Sharon J Krinsky-McHale, Florence Lai and 6 others

PMID 33314467

WHAT IT FOUND

For adults with Down syndrome, memory and language concerns on the NTG-EDSD screen were informative for early decline, but the total score was weak and produced many false positives.

Use it with other clinical information.

Key findings

01The NTG-EDSD total concern score increased with clinical progression, but the published 20-concern criterion detected only 16 of 38 dementia cases and 2 of 36 MCI-DS cases.

02Memory and Language concerns were the strongest early signal; the combined Memory and Language domain had sensitivity 0.806 for MCI-DS.

03For dementia, one or more total concerns had sensitivity 1.0 but specificity 0.522; a score of 5 or more had sensitivity 0.868 and specificity 0.802.

STILL TO COME

How it was doneWhat they foundWhat it means for OTsWhat it means for SLPs

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What it does not show

The study only looked at one time point, so it cannot show whether the NTG-EDSD detects onset of decline over time. People with more severe preclinical impairments and significant sensory or motor impairments were excluded, so results may not apply to those groups. The comparison standard was consensus case conference, which can be imperfect; disagreements may reflect errors in the standard rather than in the screen. Provisional and uncertain cases were excluded, which may limit real-world applicability. MCI diagnosis in adults with Down syndrome is difficult because lifelong cognitive and functional impairments make decline hard to judge. The screen's diagnostic history items and several domains were not well suited to early decline.

The easy way to misread this

Do not use a positive NTG-EDSD total score as a dementia diagnosis. For early decline, one or more total concerns had sensitivity 0.889 but specificity 0.522, so many stable adults would screen positive and some true MCI-DS cases can still be missed.

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