BACKGROUND: A single cutoff is widely used to screen amnestic mild @entity73 (aMCI). However, results of screening test performance are never adjusted for spectrum effect and spectrum bias. OBJECTIVES: To assess the potential impact of spectrum effect and spectrum bias on screening test performance and clinical decision. METHODS: The ability of the combination of @entity2414 Screen (MIS), the Isaacs Set Test (IST), and the Mini-Mental State Examination (MMSE) to distinguish aMCI (n=3,330) from @entity1 with subjective @entity73 (SCC) (n=1,522) was investigated across a wide range of age and educational backgrounds. The spectrum effect was defined as the variation of the sensitivity and/or the specificity across different subgroups. A spectrum bias was highlighted if the likelihood ratio (LR) observed in a subgroup of subjects statistically differed from the LR observed in the overall sample. RESULTS: For the MIS-IST pairing, the overall sensitivity and specificity were equal to 72.5% and 75.2% , the positive LR (LR+) and the negative LR (LR-) were equal to 2.91 and 0.37, respectively. Across the different age-education subgroups, the sensitivities ranged from 43.7% to 92.5% and specificities from 39.3% to 95.2%. LR+ and LR- ranged from 1.51 to 9.10 and 0.13 to 0.59, respectively. A statistically significant spectrum bias was found in some subgroups and may result in differences between the post-test probabilities. Similar results were also found for the MMSE. CONCLUSION: These findings could potentially affect the clinician's decision with a possible greater impact in elderly @entity1 with a lower educational level.

Spectrum Effect and Spectrum Bias in  the  Screening Test Performance for  XXXX : What are the Clinical Implications?

@entity1 :: ('9606', 'Species') :: ['patients'] @entity73 :: ('MESH:D003072', 'Disease') :: ['cognitive impairment', 'cognitive complaints'] @entity2414 :: ('MESH:D008569', 'Disease') :: ['Memory Impairment']
@entity73 :: (MESH:D003072,Disease) :: ['Amnestic Mild Cognitive Impairment']
