Diagnostic Accuracy of Cognitive Screening Tools Validated for Older Adults in Iran: A Systematic Review and Meta-analysis

Abstract

Abstract Background This systematic review aims to comprehensively assess the diagnostic accuracy of cognitive screening tools validated for older adults in Iran, providing evidence-based recommendations for clinicians and researchers. Methods Multiple databases were searched for cross-sectional research published until March 2033. Inclusion criteria encompassed paper and pencil cognitive screening tools used in Iranian seniors. Data extraction involved evaluating diagnostic accuracy measures, cognitive domains, and strengths/weaknesses of each test. A bivariate random-effects meta-analysis generated summary estimates with 95% CIs, and forest plots visually represented the findings. Results The review included 17 studies investigating 14 cognitive screening instruments. Diagnostic accuracy data were extracted for the Clock Drawing Test (CDT), Mini-Cog, short portable mental status questionnaire (SPMSQ), A Quick Test of Cognitive Speed (AQT), Quick Mild Cognitive Impairment (Qmci) screen, Rowland Universal Dementia Assessment (RUDAS), Picture-Based Memory Impairment Screen (PMIS), Abbreviated Mental Test Score (AMTS), Mini–Mental State Examination (MMSE), Modified Mini-Mental State Examination (3MS), Montreal Cognitive Assessment (MoCA), Addenbrooke’s Cognitive Examination (ACE)-III, Persian test of Elderly for Assessment of Cognition and Executive function (PEACE), and Rey Auditory Verbal Learning Test (RAVLT). Pooled values from the bivariate effect model for the MMSE showed a sensitivity of 0.97, specificity of 0.87, DOR of 242, LR + of 7.69, and LR- of 0.03. Conclusion The results showed that the ACE-III demonstrated the highest accuracy for dementia and mild cognitive impairment (MCI) in specialized care settings. However, the high risk of bias in many studies emphasizes the need for more rigorous validations in diverse clinical contexts and populations.