6 Cognitive Item Test (6CIT) App Review

Another Evidence-based Dementia Screening Option for iOS

In a busy primary care practice, providers frequently encounter patients and their family members who request dementia screening. Although my current clinic has a neurologist and neuropsychologist available, a fully functional dementia clinic is likely not available to most community-based primary care providers. So how does a busy primary care provider screen for dementia? There are many validated screening tools including the Mini-Cog, MoCA, MMSE, SLUMS, DST and AD8 among others. Here at iMedicalApps, we have reviewed a number of geriatrics apps including many from the American Geriatrics Society (AGS) including: Geriatrics at Your Fingertips, Multimorbidity/MCC GEMS,iGeriatrics, and AGS GEMS that contain some of these tools.

Last year, I reviewed the app AlzDxRx which helps providers screen, diagnose and manage patients with Alzheimer’s disease and contains several tools including the Mini-Cog. However, it did not contain the SLUMS or MoCa as these are proprietary screening tools. Subsequently, we favorably reviewed a dedicated SLUMS app called eSLUMS. Last month, we reviewed the Dementia Screening Tool (DST) an approved medical device from Germany with a sensitivity of 97%.

Now we have yet another dementia screener this time from the UK called the 6 Cognitive Item Test (6CIT). The test was developed in 1983 by Katzman et al in the USA, then retooled for easier used by Drs. Patrick and Jonathan Brooke in 2000 in the U.K. The test has undergone numerous validation studies and is more sensitive than the Mini-Mental Status Examination (MMSE). The 6CIT is 6 questions long, takes less than 5 minutes, and a score of 0-7 being likely within normal limits while a score of 8-28 demonstrating significant cognitive impairment and further testing required.

Evidence-based medicine

The app does not contain references for any of its content or references on the device itself, but does contain a hyperlink to the developer website. The 6CIT has been validated via numerous studies and has a sensitivity of 78-90% and specificity of 100% using a cut-off of 7/8 points. This gives the 6CIT a sensitivity/specificity greater than MMSE and on par with the MoCA and Mini-Cog while being simple to administer in less than 5 minutes making it ideal for primary care.

What providers would benefit from this App?

Students, residents, mid-levels, family medicine, internal medicine and subspecialties, and geriatrics providers. The app could really benefit any provider who sees geriatrics patients and may have to diagnose dementia.

Price

o Free.

Likes

  • Another validated dementia screener available for iOS devices
  • Data input and results easy and efficient on the iPhone
  • Hyperlink to EBM data for the 6CIT

Dislikes

  • No information regarding EBM for the test on the app itself
  • Minimal information about positive/negative results
  • Not available for Android

Overall

The 6CIT app is one of the easiest and highly validated dementia screeners available. Best of all it is free unlike the DST, MOCA and some others. It is a valuable addition to the growing library of dementia screeners available in the App store, but currently only for iOS (Android is under development, according to the developer’s website).  The app would benefit by including more of the online information regarding validation studies, development, etc., but all of the information is available via a link within the app.

Overall Score

o 4.5 stars.

User Interface

o 4.5 stars.

Super easy to use with some basic guidance provided within the app; more information online.

Multimedia Usage

o 3.5 stars.

All of the references for validation and information about the app is available via a hyperlink from the app. App itself is pretty scant on documentation.  

Price

o 5 stars.

App is free.

Real World Applicability

o 4.5 stars.

The 6CIT app is an easy to use, free, validated screening tool for dementia. Similar to other dementia screening apps reviewed on iMedicalApps, the 6CIT takes only minutes to complete and has a high sensitivity and specificity. Combined with follow-up neuropsych testing, the 6CIT app and quickly help primary care providers in making a correct diagnosis of dementia.  

Device Used For Review

o iPhone 8 running iOS 12.2.

Available for Download for iPhone and iPad. Not available for Android currently.

Disclaimer: The views expressed are those of the author(s) and do not reflect the official policy of the Department of the Army, the Department of Defense or the U.S. Government.