ORIGINAL RESEARCH article
Front. Neurosci.
Sec. Neurodegeneration
Volume 19 - 2025 | doi: 10.3389/fnins.2025.1599019
This article is part of the Research TopicEarly Dementia Detection: Memory, Cortical Function, and Biomarkers in the Classification of High-Risk Pre-Dementia Individuals in the Healthy Aging PeopleView all 6 articles
Improved Dementia Screening for Elderly with Low Education in South Korea Using the Cognitive Impairment Screening Test (CIST)
Provisionally accepted
Kyung Wook Kang1,2
Gilsoon Park2
Hyunsoo Kim1
Soo Hyun Cho1
Seong-Min Choi1Kang-Ho Choi1Hak-Loh Lee1Gwangsoon Shon3
Byeong Chae Kim1,3*
Hosung Kim2- 1Department of Neurology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
- 2USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, United States
- 3Gwangju Provincial Dementia Center, Gwangju, Republic of Korea
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Background: The Mini-Mental State Examination (MMSE) is the most widely used cognitive screening test worldwide; however, it often overdiagnoses older adults with low education levels. In contrast, the Cognitive Impairment Screening Test (CIST), developed by South Korea’s Ministry of Health and Welfare, may address this shortcoming. In this study, we compare the CIST and the Korean version of the MMSE (K-MMSE) in older adults with no formal education.Methods: We included 100 older adults (≥ 65 years)—27 with normal cognition (NC), 37 with mild cognitive impairment (MCI), and 36 with dementia (DM). All completed both the CIST and K-MMSE. First, we analyzed correlations between the CIST and K-MMSE. Next, we performed an analysis of covariance (ANCOVA), adjusting for age and sex, to compare group performance. Finally, classification performance was evaluated using receiver operating characteristic (ROC) curve analyses, examining the area under the curve (AUC) and other relevant metrics. Results: The CIST showed positive correlations with both the K-MMSE (r = 0.722) and the K-MMSE z-score (r = 0.625). ANCOVA revealed significant group differences (p < 0.001) for both measures. When distinguishing NC from MCI/DM, the CIST outperformed the K-MMSE, demonstrating a higher AUC (0.869 vs. 0.842) and F1-score (0.697 vs. 0.409).Conclusion: The CIST is a reliable and useful tool for assessing cognitive function, showing advantages over the K-MMSE in detecting cognitive decline among older adults without formal education. Further large-scale validation studies are warranted.
Keywords: Cognition, Cognitive Assessment Screening Instrument, MMSE, Cist, low education
Received: 24 Mar 2025; Accepted: 28 Apr 2025.
Copyright: © 2025 Kang, Park, Kim, Cho, Choi, Choi, Lee, Shon, Kim and Kim. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Byeong Chae Kim, Department of Neurology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
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