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Dementia & Neuropsychologia

Print version ISSN 1980-5764

Dement. neuropsychol. vol.8 no.2 São Paulo June 2014 


A systematic review and meta-analysis of the diagnostic accuracy of the Phototest for cognitive impairment and dementia


Cristóbal Carnero-Pardo1  2 

Samuel Lopez-Alcalde1  2 

Ricardo Francisco Allegri3 

María Julieta Russo3 

1Cognitive Behavioral Neurology Unit, Service of Neurology, Hospital Universitario Virgen de las Nieves, Granada, Spain.

2FIDYAN Neurocenter, Granada, España.

3Department of Cognitive Neurology, Instituto de Investigaciones Neurológicas Raúl Carrea (FLENI), Buenos Aires, Argentina.


The recently developed Phototest is a simple, easy and very brief test for detecting cognitive impairment or dementia.


To evaluate the diagnostic accuracy of the Phototest for detecting cognitive impairment or dementia.


We used a manually created database to search for studies evaluating the Phototest diagnostic yield and performed an initial meta-analysis to determine sensitivity (Sn) and specificity (Sp) of diagnostic parameters. We also performed a second meta-analysis of individual participant data.


In total, 6 studies were included in the meta-analysis. For dementia, Sn was 0.85 (95% CI, 0.82-0.88) and Sp 0.87 (95% CI, 0.85-0.99); for cognitive impairment, Sn was 0.80 (95% CI, 0.77-0.92) and Sp 0.88 (95% CI, 0.86-0.90). In the individual data meta-analysis, 1565 subjects were included, where best cut-off points for dementia and for cognitive impairment were 26/27 (Sn=0.89 (95% CI 0.85-0.91), Sp=0.84 (95% CI, 0.82-0.91)) and 28/29 (Sn=0.79 (95% CI, 0.76-0.81), Sp=0.88 (95% CI, 0.86-0.90)), respectively.


Phototest has good diagnostic accuracy for dementia and cognitive impairment. It is brief, simple and can be used in illiterate persons. This makes it suitable for use in primary care settings and/or in subjects with low educational level.

Key words meta-analysis; screening; detection; cognitive impairment; phototest; dementia


Phototest é um teste simples, fácil e muito rápido para detecção de comprometimento cognitivo e demência recentemente desenvolvido.


Avaliar a acurácia diagnostica do Phototest para detecção de comprometimento cognitivo e demência.


Nós usamos um banco de dados manualmente criado para estudos que avaliassem a capacidade diagnóstica do Phototest e realizamos uma meta-análise para determinar a sensibilidade (Sn) e especificidade (Ep) dos parâmetros diagnósticos. Nós também realizamos uma segunda meta-análise dos dados individuais dos participantes.


Um total de seis estudos foram incluídos na meta-análise. Para demência a Sn foi 0.85 (95% CI, 0,82-0,88) e Ep 0,87 (95% CI, 0,85-0,99); para comprometimento cognitivo a Sn foi 0,80 (95% CI, 0,77-0,92) e Sp 0,88 (95% CI, 0,86-0,90). Na meta-análise de dados individuais, 1565 foram incluídos, os melhores escores de corte para demência e para comprometimento cognitivo foram 26/27 (Sn=0,89 (95% CI 0,85-0,91), Ep=0,84 (95% CI, 0,82-0,91)) e 28/29 (Sn=0,79 (95% CI, 0,76-0,81), Ep=0,88 (95% CI, 0,86-0,90)), respectivamente.


Photest tem boa acurácia diagnostica para demência e comprometimento cognitivo. É breve, simples e pode ser usado em pessoas analfabetas. Tornando-o apropriado para o uso em cuidados primários e/ou sujeitos com baixo nível educacional.

Palavras-chave meta-análise; rastreio; detecção; comprometimento cogntivo; phototest; demência

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1. Carnero-Pardo C, Montoro-Rios MT. The photo test. Rev Neurol 2004;39:801-806. [ Links ]

2. Carnero Pardo C, Saez-Zea C, Montiel Navarro L, et al. Diagnostic accuracy of the Phototest for cognitive impairment and dementia. Neurologia 2007;22:860-869. [ Links ]

3. Saez-Zea C, Carnero-Pardo C, Gurpegui M. [Names of persons: a verbal fluency test without socioeducational influences]. Neurologia 2008; 23:356-360. [ Links ]

4. Harrison J. Cognitive approaches to early Alzheimer's disease diagnosis. Med clin North Am 2013;97:425-438. [ Links ]

5. Zamora J, Abraira V, Muriel A, Khan K, Coomarasamy A. Meta-DiSc: a software for meta-analysis of test accuracy data. BMC Med Res Methodol 2006;6:31. [ Links ]

6. Urrutia G, Bonfill X. [PRISMA declaration: a proposal to improve the publication of systematic reviews and meta-analyses]. Med Clin (Barc.) 2010;135:507-511. [ Links ]

7. Barreto M, Báñez Romero J, Carnero Pardo C. Evaluación del Test de las Fotos en una muestra de inmigrantes españoles residentes en Argentina. Proyecto Alzheimer. En: 5th Neuropsychiatric Iberoamerican Congress. Buenos Aires; 2008. [ Links ]

8. Russo M, Iturry M, Sraka M, Bartoloni L, Carnero Pardo C, Allegri R. [Validez discriminativa del Test de las Fotos en una muestra de pacientes con deterioro cognitivo y demencia en Argentina]. En: XLIX Congreso Argentino de Neurología. Mar del Plata, Argentina; 7-10 November 2012. [ Links ]

9. Contador I, Fernandez-Calvo B, Ramos F, Tapias-Merino E, Bermejo-Pareja F. The use of the Fototest in screening for dementia in primary care. Reply. Rev Neurol 2011;52:704. [ Links ]

10. Carnero-Pardo C. [The use of the Fototest in screening for dementia in primary care]. Rev Neurol 2011;52:639-640. [ Links ]

11. Carnero-Pardo C, Saez-Zea C, Montiel-Navarro L, Feria-Vilar I, Gurpegui M. Normative and reliability study of fototest. Neurologia 2011;26: 20-25. [ Links ]

12. Baos Sánchez L, Ruiz Muñoz MÁ, Bernal López MD, Ballester Rodríguez B, Ángora Mazuecos F. Estudio de la validez del Test de las Fotos en el cribado de Deterioro Cognitivo en Atención Primaria. Rev Clín Med Fam 2007;2:57-62. [ Links ]

13. Carnero-Pardo C, Espejo-Martinez B, Lopez-Alcalde S, et al. Effectiveness and costs of Phototest in dementia and cognitive impairment screening. BMC Neurol 2011;11:92. [ Links ]

14. Carnero-Pardo C, Espejo-Martinez B, Lopez-Alcalde S, et al. Diagnostic accuracy, effectiveness and cost for cognitive impairment and dementia screening of three short cognitive tests applicable to illiterates. PLoS One 2011;6:e27069. [ Links ]

15. Carnero-Pardo C, Saez-Zea C, De la Vega Cotarelo R, Gurpegui M, en nombre del grupo F. [FOTOTRANS study: multicentre study on the validity of Fototest under clinical practice conditions]. Neurologia 2012; 27:68-75. [ Links ]

16. Carnero Pardo C, de la Vega Cotarelo R, Lopez Alcalde S, et al. Assessing the diagnostic accuracy (DA) of the spanish version of the informant-based AD8 questionnaire. Neurologia 2013;28:88-94. [ Links ]

17. American Psychiatry Association. Diagnostic and Statistical Manual of Mental Disorders (4th ed, Text Revision) DSM-IV-TR. Washingyon DC: American Psychiatric Association; 2000. [ Links ]

18. Robles A, Del Ser T, Alom J, Pena-Casanova J, Grupo Asesor del Grupo de Neurologia de la Conducta y Demencias de la Sociedad Espanola de N. [Proposal of criteria for clinical diagnosis of mild cognitive impairment, dementia and Alzheimer's disease]. Neurologia 2002;17:17-32. [ Links ]

19. McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology 1984;34: 939-944. [ Links ]

20. Winblad B, Palmer K, Kivipelto M, et al. Mild cognitive impairment--beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. J Int Med 2004;256: 240-246. [ Links ]

21. Galvin JE, Roe CM, Powlishta KK, et al. The AD8: a brief informant interview to detect dementia. Neurology 2005;65:559-564. [ Links ]

22. Deeks JJ, Altman DG. Diagnostic tests 4: likelihood ratios. BMJ. 2004; 329:168-169. [ Links ]

23. Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198. [ Links ]

24. Mitchell A. The Mini-Mental State Examination (MMSE): an update on its diagnostic validity for cognitive disorders. In: Larner A, ed. Cognitive Screening Instruments A Practical Approach. London: Springer; 2013:15-46. [ Links ]

25. Carnero-Pardo C. Should the Mini-Mental State Examination be retired? Neurologia. 2013. doi: 10.1016/j.nrl.2013.07.003. [ Links ]

26. Carnero-Pardo C, Montoro-Rios MT. [Preliminary evaluation of a new screening test for dementia (Eurotest)]. Rev Neurol 2004;38:201-209. [ Links ]

27. , Carnero Pardo C Espejo Martínez B, Montoro Rios MT. Revisión sistemática y metaanálisis de la utilidad diagnóstica del Eurotest en la identificación de demencia. Alzheimer Real Invest Demenc 2009;42: 14-22. [ Links ]

28. Shulman KI. Clock-drawing: is it the ideal cognitive screening test? Int J Geriatr Psychiatry 2000;15:548-561. [ Links ]

29. Pinto E, Peters R. Literature review of the Clock Drawing Test as a tool for cognitive screening. Dement Geriatr Cogn disord 2009;27:201-213. [ Links ]

30. Cacho J, Benito-Leon J, Garcia-Garcia R, Fernandez-Calvo B, Vicente-Villardon JL, Mitchell AJ. Does the combination of the MMSE and clock drawing test (mini-clock) improve the detection of mild Alzheimer's disease and mild cognitive impairment? J Alzheimer Dis 2010;22:889-896. [ Links ]

31. Carnero-Pardo C, Cruz-Orduña I, Espejo Martínez B, Martos- Aparicio C, López Alcalde S, Olazarán J. Utility of the Mini-Cog for detection of cognitive impairment in Primary Care: data from two spanish studies. Int J Alzheimer Dis 2013;2013:ID 285462. [ Links ]

32. Kim H, Chey J. Effects of education, literacy, and dementia on the Clock Drawing Test performance. J Int Neuropsychol Soc 2010;16:1138-1146. [ Links ]

Received: March 20, 2014; Accepted: May 30, 2014

Cristóbal Carnero Pardo. Service of Neurology, Hospital Universitario Virgen de las Nieves. Avenida de Madrid s/n -18014 - Granada Spain. E-mail:

Disclosure: The authors report no conflicts of interest.

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