Dementia Screening Program Research Articles

The wisconsin memory screening initiative: Rationale and results

A large proportion of persons with dementia are frequently not diagnosed or are diagnosed at late stages of the disease limiting the ability to implement pharmacologic and caregiver interventions that may reduce the need for long term care services. Because of the significant impact of dementia on the utilization of long term care and because of the potential for cost savings from better management of dementia symptoms and early support of caregivers,the State of Wisconsin and the Wisconsin Alzheimer's Institute piloted a dementia screening program in existing county long term care systems. Aging and long term care staff in eight counties were provided with a basic understanding of dementia, available treatments and supportive services, and were trained in the administration of cognitive screening tools. Physicians and other health professionals in the target counties were trained in how to interpret the screening results and in the diagnosis of cognitve disorders. Persons over age 65 and known not to have a dementia diagnosis were screened initially with the Animal Naming test and if screening positive,were tested with a second screen,the Cognistat. All results were sent to the person's physician for evaluation. The outcome of the physician evaluation was recorded whenever available. 1,355 persons were approached for screening. Ninety-one percent agreed to be screened and of these, 34% screened positive on the Animal Naming test. Eighty-six percent of persons screening positive agreed to additional testing with the Cognistat. Of these, 93% had impaired scores and were referred to a physician for evaluation. Follow up data were available for 108 referrals and of these, 60 received a dementia related diagnosis . Of the remaining 48, the abnormal screening results were attributed to a non dementia cause or no explanation was given. This pilot study found that cognitive screening by county staff is feasible and well accepted by participants. The prevalence of unrecognized cognitive impairment was high but consistent with other studies. Physician follow up of positive screens was inconsistent suggesting that physicians may be important barriers for states seeking to contain long term care costs.

Correlates of dementia among subjects of the national dementia screening and registration program

To determine the correlates of dementia among the subjects of the National Dementia Screening and Registration Program. A total of 536 subjects were included as they are decided to have to have a further evaluation for dementia. CERAD-K, MMSE-KC, BDS-ADL, K-GDS were used 10 check cognitive function and activity of daily Iiving, and depression and finally to diagnose dementia. mutliple logistic regression analysis was done to investigate correlates of dementia. The lower the education years the higher the risk of having dementia(OR=0.893, 95% CI 0.808-0.985) ,and those persons who are inslit내ionalized were 11.433 times (95% CI 1.546-84.570) more Iikely to have dementia diagnosis. 1t is needed to extend life long education programs such as the elder's college for preventing dementia and social support system that could prevent institutionalization

The Memory Screening Outreach Program: Findings from a Large Community‐Based Sample of Middle‐Aged and Older Adults

Few papers have been published concerning the efficacy of community-based memory and dementia screening programs. This article examines the descriptive, clinical, and outcome characteristics of participants attending the Memory Screening Outreach Program (MSOP). The program provided free screenings of participants' short-term memory processes, neurocognitive complaints, and depressive and psychiatric symptomatology. Screening results were subsequently forwarded to participants and their designated healthcare providers (HCPs), and approximately 8 weeks later, participants who received follow-up recommendations were mailed a survey assessing screening-related outcomes. One thousand community-based persons aged 44 to 91 participated in the program at 16 screening sites. Results indicated that 44.3% of the MSOP participants received follow-up recommendations secondary to age-inappropriate memory impairments, depressive or psychiatric symptomatology, significant neurocognitive complaints, need for respite, or a combination thereof. Memory impairments and depressive or psychiatric symptomatology contributed, at least in part, to the recommendations of 24.0% and 30.9% of the sample, respectively. The prevalence of impaired Wechsler Memory Scale-III subtest performances ranged from 20.5% to 5.4%, and 28.7% of the participants exhibited elevated depression inventory scores. Of the participants who returned follow-up surveys, 49.5% visited their primary HCPs regarding their screening results; of the participants who had not followed up, 36.8% indicated plans to do so. Of the participants who followed up, contributing conditions and diagnoses were identified in 50.9%, medication or supplement recommendations or regimen changes were provided to 47.1%, and 17.0% were referred to healthcare specialists. Overall, the MSOP proved efficacious in identifying age-inappropriate memory impairments, notable depressive and psychiatric symptomatology, and significant neurocognitive complaints in an appreciable portion of a large, community-based, sample of middle-aged and older adults, which, in turn, contributed to the identification and treatment of a diversity of conditions at follow-up.

Patients' attitudes of dementia screening across the Atlantic

Dementia is a common and growing global public health problem. It leads to a high burden of suffering for society with an annual cost of $100 billion in the US and $10 billion in the UK. New strategies for both treatment and prevention of dementia are currently being developed. Implementation of these strategies will depend on the presence of a viable community or primary care based dementia screening and diagnosis program and patient acceptance of such a program. To compare the acceptance, perceived harms and perceived benefits of dementia screening among older adults receiving their care in two different primary health care systems in two countries. A Cross-sectional study. Primary care clinics in Indianapolis, USA and Kent, UK. A convenience sample of 245 older adults (Indianapolis, n = 125; Kent, n = 120). Acceptance of dementia screening and its perceived harms and benefits as determined by a 52-item questionnaire (PRISM-PC questionnaire). Four of the five domains were significantly different across the two samples. The UK sample had significantly higher dementia screening acceptance scores (p < 0.05); higher perceived stigma scores (p < 0.05); higher perceived loss of independence scores (p < 0.01); and higher perceived suffering scores (p < 0.01) than the US sample. Both groups perceived dementia screening as beneficial (p = 0.218). After controlling for prior experience with dementia, acceptance and stigma were marginalized. Older adults attending primary care clinics across the Atlantic value dementia screening but have significant concerns about dementia screening although these concerns differed between the two countries. Low acceptance rates and high rates of perceived harms might be a significant barrier for the introduction of treatment or preventive methods for dementia in the future.

The costs and benefits of a screening program to detect dementia in older drivers.

A Markov model was used to assess the cost-benefit ratios of six strategies of screening older drivers for mental status, beginning at age 65. Probabilities of motor vehicle collisions (MVCs), injuries, and fatalities were obtained from national data. Dementia prevalence, test characteristics, and costs were obtained from the literature. Costs included lost wages, car ownership, alternative transportation, and injuries. Using a relative risk of MVC for those with dementia of 5 and a 5% annual discounting rate, the average cost per driver ranged from $51,600 (no testing) to $58,400 (testing every five years). The benefit was < one day of life gained, and the benefits of screening cost approximately 2.8 million dollars per life-year gained. Increasing the relative risk from 5 to 20 substantially improved the cost-benefit of mental status screening. However, mental status screening of older drivers would also be cost-beneficial if physician referral costs were lowered to $60 per evaluation. The authors conclude that a dementia screening program for older drivers would be cost-beneficial if physician evaluations were limited or their cost lowered to < or = $60.

Population-based dementia screening program in Kuopio: the effect of education, age, and sex on brief neuropsychological tests.

A neuropsychological screening battery including the Mini-Mental State Examination and four other brief cognitive tests (Russell's Adaptation of the Visual Reproduction Test, Trail Making Test, Verbal Fluency Tests on letters and category, and the Buschke Selective Reminding Test) was administered to a randomly selected population sample of 403 subjects aged 68 to 77 years to evaluate the effect of education, age, and sex on test scores. The difference in neuropsychological screening tests between various education groups (3 years or less, 4 to 6 years, 7 years or more) was statistically highly significant, even after the adjustment for the effect of age. The subscores and total scores were lowest in the minimal education group on every neuropsychological test. Education correlated more strongly than age with all neuropsychological test scores and subscores. The effect of sex on test results was seen only in some subscores of brief neuropsychological tests but not in a single item of the Mini-Mental State Examination. On the basis of our results, the effects of education, age, and sex have to be evaluated before using brief neuropsychological tests in population-based dementia screening.