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The Sweet 16

Tamara G. Fong, MD, PhD; Richard N. Jones, ScD; James L. Rudolph, MD, SM; Frances M. Yang, PhD; Douglas Tommet, MS; Daniel Habtemariam, BA; Edward R. Marcantonio, MD, SM; Kenneth M. Langa, MD, PhD; Sharon K. Inouye, MD, MPH

Arch Intern Med. 2011;171(5):432-437. doi:10.1001/archinternmed.2010.423

Background  Cognitive impairment is often unrecognized among older adults. Meanwhile, current assessment instruments are underused, lack sensitivity, or may be restricted by copyright laws. To address these limitations, we created a new brief cognitive assessment tool: the Sweet 16.

Methods  The Sweet 16 was developed in a cohort from a large post–acute hospitalization study (n = 774) and compared with the Mini-Mental State Examination (MMSE). Equipercentile equating identified Sweet 16 cut points that correlated with widely used MMSE cut points. Sweet 16 performance characteristics were independently validated in a cohort from the Aging, Demographics, and Memory Study (n = 709) using clinical consensus diagnosis, the modified Blessed Dementia Rating Scale, and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE).

Results  The Sweet 16 correlated highly with the MMSE (Spearman r, 0.94; P < .001). Validated against the IQCODE, the area under the curve was 0.84 for the Sweet 16 and 0.81 for the MMSE (P = .06). A Sweet 16 score of less than 14 (approximating an MMSE score <24) demonstrated a sensitivity of 80% and a specificity of 70%, whereas an MMSE score of less than 24 showed a sensitivity of 64% and a specificity of 86% against the IQCODE. When compared with clinical diagnosis, a Sweet 16 score of less than 14 showed a sensitivity of 99% and a specificity of 72% in contrast to an MMSE score with a sensitivity of 87% and a specificity of 89%. For education of 12 years or more, the area under the curve was 0.90 for the Sweet 16 and 0.84 for the MMSE (P = .03).

Conclusions  The Sweet 16 is simple, quick to administer, and will be available open access. The performance of the Sweet 16 is equivalent or superior to that of the MMSE.

Author Affiliations: Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts (Drs Fong, Jones, Rudolph, Yang, and Inouye and Messrs Tommet and Habtemariam); Departments of Neurology (Dr Fong) and Medicine (Drs Yang, Marcantonio, and Inouye), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston; Veterans Affairs Boston Healthcare System, Geriatric, Research, Education, and Clinical Center (Dr Rudolph); Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Boston (Dr Rudolph); Department of Internal Medicine, University of Michigan Medical School, Ann Arbor (Dr Langa); and Ann Arbor Veterans Affairs Health Services Research and Development Center of Excellence (Dr Langa).

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