Abstract
Background: Under conditions of high demand for primary care services in a setting of low financial resources, there is need for brief, easily administered cognitive screening tools for use in the primary care setting, especially in rural areas. However, interpretation of these cognitive tests’ results requires knowledge on their susceptibility to cultural, educational and demographic patient characteristics.Objectives: To assess the clinical validity of the ‘Test Your Memory’ (TYM) and ‘General Practitioner assessment of Cognition’ (GPCog) which was specifically designed for primary care practice, in a rural primary care setting in Greece, utilizing the ‘Mini Mental State Examination’ (MMSE) as a reference standard.Methods: The MMSE, TYM, and GPCog were administered to a random sample of 319 community dwelling Greek adults aged 60 to 89 years in 11 rural Primary Healthcare Centres of the Prefecture of Heraklion on the island of Crete, Greece. Analyses examined (a) The association of each instrument with demographic factors and MMSE and (b) optimal cut-off scores, sensitivity and specificity against MMSE-based cognitive impairment risk using ROC analyses with the MMSE 23/24 point cut-off as a reference standard.Results: We found a sensitivity of 80% and a specificity of 77% for TYM (35/36 or 38/39 cut-off, depending on education). Corresponding values were 89% and 61% for GPCog (7/8 cut-off), respectively.Conclusion: The TYM and GPCog instruments appear to be suitable for routine use in the primary care setting as tools for cognitive impairment risk detection in elderly rural populations.
Highlights
Detection of early signs of dementia is crucial and may be missed in a busy primary care practice until functional impairment becomes apparent [1]
The General Practitioner assessment of Cognition (GPCog)-Patient scale is a much shorter instrument that can be completed in less than 4 min by a health professional [5]. Both instruments have been translated into several languages and their clinical validity has been assessed for detecting possible cognitive impairment against other screening instruments and/or clinical diagnosis of dementia [1,4,6]
Moderated regression analyses further established that the magnitude of associations between Test Your Memory’ (TYM)-Mini Mental State Examination’ (MMSE) and GPCog-MMSE did not vary with education level
Summary
Detection of early signs of dementia is crucial and may be missed in a busy primary care practice until functional impairment becomes apparent [1]. Since the vast majority of validation studies have been conducted with clinical samples recruited primarily in urban settings, it is crucial to assess the validity of these new instruments for detecting risk for cognitive impairment in rural elderly populations, which are characterized by limited formal education [7]. This need is supported by considerable suggested adjustments to MMSE cut-offs [7,8,9,10], potentially increasing false-negative rates in detecting dementia. Conclusion: The TYM and GPCog instruments appear to be suitable for routine use in the primary care setting as tools for cognitive impairment risk detection in elderly rural populations
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