Diagnostic performance of the six-item cognitive impairment test as first-step screening for dementia: a meta-analysis

Objective: Dementia, a slowly progressive disease, is poorly diagnosed. One reason is that it is difficult to use the screening tools. The six-item cognitive impairment test (6-CIT) is brief, with six items, and has a confirmed scoring system that can easily be used by an average individual. This review aimed to analyze the predictive validity of the 6-CIT including comparisons with other tools such as the Mini-Mental State Examination (MMSE). Methods: Literature searches were performed on the MEDLINE, EMBASE, CINAHL, and PsycArticles using the dementia and 6-CITas keywords. The Quality Assessment of Diagnostic Accuracy Studies-2 was applied to assess the risk of bias. Results: Seven studies with 6,831 participants that met the selection criteria were included. The pooled sensitivity of the 6-CIT analyzed in seven studies was 0.82 (95% CI 0.73-0.89), the pooled specificity was 0.87, and the summary receiver operating characteristic (sROC) curve was 0.90 (SE = 0.04). The diagnostic performance of the 6-CIT and MMSE was compared in three studies. The pooled sensitivity of the 6-CIT was 0.85, the pooled specificity was 0.91, and the sROC curve was 0.91, whereas the MMSE values were 0.70, 0.93, and 0.68, respectively. Conclusion: This review presents evidence that the 6-CIT has excellent dementia screening performance and could be used as a potential alternative to the MMSE. The 6-CIT may provide an opportunity for early detection of dementia.