Screening For Dementia In Primary Care Research Articles

Health economic analysis of the integrated cognitive assessment tool to aid dementia diagnosis in the United Kingdom.

The aim of this study was to develop a comprehensive economic evaluation of the integrated cognitive assessment (ICA) tool compared with standard cognitive tests when used for dementia screening in primary care and for initial patient triage in memory clinics. ICA was compared with standard of care comprising a mixture of cognitive assessment tools over a lifetime horizon and employing the UK health and social care perspective. The model combined a decision tree to capture the initial outcomes of the cognitive testing with a Markov structure that estimated long-term outcomes of people with dementia. Quality of life outcomes were quantified using quality-adjusted life years (QALYs), and the economic benefits were assessed using net monetary benefit (NMB). Both costs and QALYs were discounted at 3.5% per annum and cost-effectiveness was assessed using a threshold of £20,000 per QALY gained. ICA dominated standard cognitive assessment tools in both the primary care and memory clinic settings. Introduction of the ICA tool was estimated to result in a lifetime cost saving of approximately £123 and £226 per person in primary care and memory clinics, respectively. QALY gains associated with early diagnosis were modest (0.0016 in primary care and 0.0027 in memory clinic). The net monetary benefit (NMB) of ICA introduction was estimated at £154 in primary care and £281 in the memory clinic settings. Introduction of ICA as a tool to screen primary care patients for dementia and perform initial triage in memory clinics could be cost saving to the UK public health and social care payer.

The applicability of the cognitive abilities screening instrument-short (CASI-S) in primary care in Brazil.

The Cognitive Abilities Screening Instrument - Short (CASI-S) is a brief cognitive screening test. However, there is limited information regarding its applicability in primary care. To ascertain whether the CASI-S differentiates between dementia patients and normal controls in primary care; to examine its correlation with other cognitive instruments, to analyze its internal consistency, test-retest stability, and diagnostic accuracy. In a case-control study, carried out at two Primary Care Units (PCUs) in the eastern region of the city of São Paulo, 47 older adults were diagnosed with dementia according to DSM-IV criteria (mean age = 76.81 ± 7.03 years), and 55 were classified as normal controls (mean age = 72.78 ± 7.37 years), by a multidisciplinary panel which had access to results from a comprehensive cognitive battery and the patients' health data. The present analyses included results from the Mini-Mental State Examination (MMSE). The CASI-S was not used to determine diagnostic status. The CASI-S was easily applied in the primary care setting. There was a significant performance difference (p < 0.001) between dementia patients (15.57 ± 7.40) and normal controls (26.67 ± 3.52) on the CASI-S. CASI-S scores correlated with age (ρ = -0.410, p < 0.001), educational level (ρ = 0.373, p < 0.001), and MMSE score (ρ = 0.793, p < 0.001). The internal consistency of the CASI-S was high (α = 0.848) and the correlation between test and retest was 0.688, suggesting adequate temporal stability. In the ROC curve analyses, scores of 22/23 generated an area under the curve of 0.907, with sensitivity of 93% and specificity of 81%. The CASI-S can be useful for dementia screening in primary care in Brazil.

A Quick Test of Cognitive Speed: norm-referenced criteria for 121 Italian adults aged 45 to 90 years.

ABSTRACT Background: A Quick Test of Cognitive Speed (AQT) is a brief test that can identify cognitive impairment. AQT has been validated in Arabic, English, Greek, Japanese, Norwegian, Spanish, and Swedish. The aim of this study was to develop Italian criterion-referenced norms for AQT. Methods: AQT consists of three test plates where the patient shall rapidly name (1) the color of 40 blue, red, yellow, or black squares (AQT color), (2) the form of 40 black figures (circles, squares, triangles, or rectangles; AQT form), (3) the color and form of 40 figures (consisting of previous colors and forms; AQT color-form). The AQT test was administered to 121 Italian cognitively healthy primary care patients (age range: 45-90 years). Their mean Mini-Mental State Examination (MMSE) score was 28.8 ± 0.9 points (range 26-30 points). AQT naming times in seconds were used for developing preliminary criterion cut-off times for different age groups. Results: Age was found to have a significant moderate positive correlation with AQT naming times color (r = 0.65, p < 0.001), form (r = 0.53, p < 0.001), color-form (r = 0.63, p < 0.001) and a moderate negative correlation with MMSE score (r = -0.44, p < 0.001) and AQT naming times differed significantly between younger (45-55 years old), older (56-70 years old), and the oldest (71-90 years old) participants. Years of education correlated positively but weakly with MMSE score (r = 0.27, p = 0.003) and negatively but weakly with AQT color (r = -0.16, p = ns), form (r = -0.24, p = 0.007), and color-form (r = -0.19, p = 0.005). We established preliminary cut-off times for the AQT test based on +1 and +2 standard deviations according to the approach in other languages and settings. Conclusions: This is the first Italian normative AQT study. Future studies of AQT - a test useful for dementia screening in primary care - will eventually refine cut-off times for normality balancing sensitivity and specificity in cognitive diagnostics.

Dementia Screening in Primary Care: Not Too Fast!

A fundamental tenet of any screening program is that it should “reduce individual and societal burden from specific disorders.”1 Screening is predicated on the assumption that early detection and subsequent treatment will improve the clinical course for individuals without symptoms. Conversely, when an individual presents with complaints of memory problems, the physician engages in case-finding. 1 Screening for some conditions in some populations has resulted in improvements in individual and societal burdens of diseases (e.g., colon and breast cancer), but screening can also cause individual and societal harm (e.g., prostate-specific antigen testing). According to the 2003 report of the U.S. Preventive Services Task Force, there is insufficient evidence to recommend for or against routine screening for dementia in primary care.2

P1‐076: Specific types of memory complaints may provide an early warning sign of cognitive impairment in community‐dwelling older adults

Early diagnosis is critical to efforts aimed at improving treatment, care, and outcomes for persons with dementia. Routine, population-based dementia screening in primary care has been met with resistance among many in the medical profession. Subjective memory complaints may be the first sign a provider confronts when a patient is experiencing cognitive decline. However, because complaints are so common among older adults, they are frequently attributed to normal aging or disregarded altogether. The Cognitive Change Checklist (3CL) is a brief, 28-item self-report inventory of cognitive change. Several studies support its use in differentiating older adults with true cognitive impairment from healthy individuals with normal, age-related memory complaints. Adults aged >55 years old, living in the community without a memory loss diagnosis were recruited for participation in the Minnesota Memory Project, a longitudinal study investigating cognitive and lifestyle factors associated with advancing age. Baseline assessments included cognitive screening (Montreal Cognitive Assessment; MoCA), brief neuropsychological testing (learning/memory, attention/concentration, cognitive/motor speed, visuospatial, executive functioning), self-report inventories, health history, and lifestyle information. For data analysis, the sample was divided into two groups, normal and impaired, using established cut-points for MCI on the MoCA. Cognitive complaint profiles on the 3CL were analyzed and correlated with objective cognitive performance on neuropsychological testing. Enrolled subjects (n = 204) ranged in age from 55–89 (M = 70) and were generally female (80%), non-Hispanic White (98%), and retired (52%). Forty-Six percent of subjects scored in the impaired range (<25) on MoCA testing. More subjective memory complaints on the 3CL were associated with greater impairment on the MoCA as well as more significant cognitive deficits as measured by various neuropsychological tests sensitive to early dementia. Item-analysis of the 3CL revealed 5 critical items with particular sensitivity in differentiating normal subjects from those with cognitive impairment. These critical items reflected specific complaints regarding select aspects of comprehension, recent, and remote memory. Results of this study provide support for the 3CL as a brief measure to quantify memory complaints and to facilitate earlier identification of individuals with possible MCI and dementia. Specific types of memory/cognitive complaints differentiated the worried well from those with suspected cognitive impairment.

Effect of patient perceptions on dementia screening in primary care.

To determine individuals' perceptions concerning dementia screening and to evaluate the possibility of an association between their perceptions and their willingness to undergo screening. Cross-sectional study of primary care patients aged 65 and older. Urban primary care clinics in Indianapolis, Indiana, in 2008 to 2009. Five hundred fifty-four primary care patients without a documented diagnosis of dementia. The Perceptions Regarding Investigational Screening for Memory in Primary Care Questionnaire (PRISM-PC) and agreement or refusal to undergo dementia screening. Of the 554 study participants who completed the PRISM-PC, 65.5% were aged 70 and older, 70.0% were female, and 56.5% were African American; 57 (10.3%) refused screening for dementia. Of the 497 (89.7%) who agreed to screening, 63 (12.7%) screened positive. After adjusting for age, perception of depression screening, perception of colon cancer screening, and belief that no treatment is currently available for Alzheimer's disease, the odds of refusing screening were significantly lower in participants who had higher PRISM-PC domain scores for benefits of dementia screening (odds ratio (OR) = 0.85, 95% confidence interval (CI) = 0.75-0.97; P = .02). In the same regression model, the odds of refusing screening were significantly higher in participants aged 70 to 74 (OR = 5.65, 95% CI = 2.27-14.09; P < .001) and those aged 75 to 79 (OR = 3.63, 95% CI = 1.32-9.99; P = .01) than in the reference group of patients aged 65 to 69. Age and perceived benefit of screening are associated with acceptance of dementia screening in primary care.

Patients' attitudes and acceptance of dementia screening in primary care

Patients' attitudes and acceptance of dementia screening in primary care

Name Correction in: Dementia Screening in Primary Care: Is It Time?

Name Correction in: Dementia Screening in Primary Care: Is It Time?

Dementia Screening in Primary Care

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The GPCOG: a new screening test for dementia designed for general practice.

To design and test a brief, efficient dementia-screening instrument for use by general practitioners (GPs). The General Practitioner Assessment of Cognition (GPCOG) consists of cognitive test items and historical questions asked of an informant. The validity of the measure was assessed by comparison with the criterion standard of diagnoses of dementia derived from the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition). Primary care doctors' offices. Sixty-seven GPs administered the GPCOG to 283 community-dwelling patients aged 50 to 74 with memory complaints or aged 75 and older. The Cambridge Mental Disorder of the Elderly Examination, the Abbreviated Mental Test (AMT), the Mini-Mental State Examination (MMSE), the 15-item Geriatric Depression Scale, and the 12-item Short-Form Health Survey. The GPCOG was reliable and superior to the AMT (and possibly to the MMSE) in detecting dementia. The two-stage method of administering the GPCOG (cognitive testing followed by informant questions if necessary)had a sensitivity of 0.85, a specificity of 0.86, a misclassification rate of 14%, and positive predictive value of 71.4%. Patient interviews took less than 4 minutes to administer and informant interviews less than 2 minutes. The instrument was reported by GPs to be practical to administer and was acceptable to patients. The GPCOG is a valid, efficient, well-accepted instrument for dementia screening in primary care.