General Practitioner Assessment Of Cognition Research Articles

Two-Year Longitudinal Study Reveals That Long COVID Symptoms Peak and Quality of Life Nadirs at 6-12 Months Postinfection.

Few longitudinal studies available characterize long COVID outcomes out to 24 months, especially in people with nonsevere acute coronavirus disease 2019 (COVID-19). This study sought to prospectively characterize incidence and duration of long COVID symptoms and their association with quality of life (QoL) from 1-24 months after mild-to-moderate COVID-19 using validated tools in a diverse cohort of unvaccinated people infected with SARS-CoV-2 in 2020. At 1-3, 6, 12, 18, and 24 months post-COVID-19, 70 participants had orthostatic vital signs measured, provided blood, and completed surveys characterizing symptoms, QoL, and return to pre-COVID-19 health and activities using validated tools (FLU-PRO+, Fatigue Severity Scale, Insomnia Severity Index, General Practitioner Assessment of Cognition, Patient Health Questionnaire Depression 8-Item, Generalized Anxiety Disorder 7-Item, 36-Item Short-Form Health Survey, EuroQol EQ-5D-5L). During the study period, 33% of participants experienced long COVID (had not returned to pre-COVID-19 health status and reported at least 1 symptom >90 days postinfection); 8% had not returned to their pre-COVID-19 health status 24 months postinfection. Long COVID symptoms peaked 6 months post-COVID-19, frequently causing activity limitations. Having long COVID was significantly associated with decreased QoL in multiple domains. Frequencies of orthostatic hypotension and tachycardia reflected levels reported in the general population. Within-person weight increased significantly between months 1 and 6. Long COVID was associated with pre-COVID-19 obesity and hyperlipidemia, but not with high-sensitivity C-reactive protein levels 1-3 months postinfection. Long COVID occurs in a significant proportion of unvaccinated people, even if the acute illness was not severe. Long COVID prevalence peaked 6-12 months post-COVID-19, and a small proportion of participants still reported not returning to their pre-COVID-19 health status 24 months post-COVID-19.

Dementia Screening in the Elderly with Chronic Disease Using the General Practitioner Assessment of Cognition

Dementia Screening in the Elderly with Chronic Disease Using the General Practitioner Assessment of Cognition

Impact of welding occupation on serum aluminium level and its association with physical health, cognitive function, and quality of life: a cross-sectional study.

There is an occupational health concern about welders' inhalation of toxic aluminium fumes. We investigated whether serum aluminium level (SAL) and demographic variables can significantly predict physical health parameters, cognition, and quality of life (QoL) among welders. The cross-sectional study involved 100 age- and location-matched men (50 welders and 50 non-welders). SAL obtained using a graphite furnace atomic absorption spectrometer, and data collected using blood pressure and body mass index (BMI) apparatuses, biodata form, pain rating scale, General Practitioner Assessment of Cognition, WHOQoL-BREF, and Nordic musculoskeletal symptoms (MSS) questionnaire were analysed using independentsamplest test, chi-square, Pearson's correlation, and hierarchical linear regression. Welders had significantly higher SAL (mean difference [MD] = 1.77µg/L, p < 0.001), lower QoL (MD = 3.92, p = 0.039), and higher prevalence of MSS on the neck (χ2 = 10.187, p = 0.001), shoulder (χ2 = 9.007, p = 0.003), upper back (χ2 = 6.832, p = 0.009), and knee (χ2 = 12.190, p < 0.001) than non-welders. There was a significant bivariate association between SAL, systolic blood pressure (β = 0.313, p = 0.002), and BMI (β = 0.279, p = 0.005), but not pain intensity, cognition, or QoL. SAL remained a significant predictor of systolic blood pressure after adjustment for physical health and QoL parameters (β = 0.191, p = 0.044). The association between SAL and social QoL became significant after adjustment for physical health and other QoL domains (β = - 0.210, p = 0.032) and demographic variables (β = - 0.233, p = 0.046). Welders had significantly higher SAL, musculoskeletal symptoms, blood pressure, and lower QoL than non-welders. SAL was associated with adverse physical health parameters and social-related QoL, not cognition. We recommend routine aluminium bioavailability and physical health checks among welders.

Alzheimer's disease with frailty: Prevalence, screening, assessment, intervention strategies and challenges.

Alzheimer's disease (AD) is a neurodegenerative disorder that affects millions worldwide and is expected to surge in prevalence due to aging populations. Frailty, characterized by muscle function decline, becomes more prevalent with age, imposing substantial burdens on patients and caregivers. This paper aimed to comprehensively review the current literature on AD coupled with frailty, encompassing prevalence, screening, assessment, and treatment while delving into the field's challenges and future trajectories. Frailty and AD coexist in more than 30% of cases, with hazard ratios above 120% indicating a mutually detrimental association.Various screening tools have emerged for both frailty and AD, including the Fried Frailty Phenotype (FP), FRAIL scale, Edmonton Frailty Scale (EFS), Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Clock Drawing Test (CDT), and General Practitioner Assessment of Cognition (GPCOG). However, none has solidified its role as the definitive gold standard. The convergence of electronic health records and brain aging biomarkers heralds a new era in AD with frailty screening and assessment. In terms of intervention, non-pharmacological strategies spanning nutrition, horticulture, exercise, and social interaction, along with pharmacological approaches involving acetylcholinesterase inhibitors (AChEIs), N-methyl-D-aspartate (NMDA) receptor antagonists, and anti-amyloid beta-protein medications, constituted cornerstones for treating AD coupled with frailty. Technological interventions like repetitive transcranial magnetic stimulation (rTMS) also entered the fold. Notably, multi-domain non-pharmacological interventions wield considerable potential in enhancing cognition and mitigating disability. However, the long-term efficacy and safety of pharmacological interventions necessitate further validation. Diagnosing and managing AD with frailty present several daunting challenges, encompassing low rates of early co-diagnosis, limited clinical trial evidence, and scarce integrated, pioneering service delivery models. These challenges demand heightened attention through robust research and pragmatic implementation.

Factors influencing mobility among people post-surgery for hip fractures: A cross-sectional study.

After hip fracture surgery, patients often experience complications and a decline in mobility, leading to physical disability and increased dependency on caregivers. This may result in reduced independence, institutionalization, and higher mortality rates. However, there is limited research on mobility and its influencing factors in patients undergoing hip fracture surgery in Thailand. This study aimed to determine the factors influencing mobility in patients with fractured hips within one year after surgery. A cross-sectional study was conducted involving 143 randomly selected participants who had undergone hip fracture surgery between August 2022 to February 2023. Mobility and its influencing factors were measured using standardized questionnaires, including the De Morton Mobility Index, Parker Mobility Scale, Charlson Comorbidity Index, General Practitioner Assessment of Cognition, Groningen Orthopedic Social Support Scale, Fatigue Severity Scale, Pain Rating Scale, and Pittsburgh Sleep Quality Index. Descriptive statistics and multiple regression were utilized for data analysis. The mean mobility score for the patients was 48.86 out of 100 (SD = 17.89). The study found that comorbidity (β = -0.156, p = 0.009), cognitive function (β = 0.310, p <0.001), social support (β = 0.145, p = 0.010), pain (β = -0.176, p = 0.004), fatigue (β = -0.249, p <0.001), and sleep (β = -0.169, p = 0.009) collectively influenced mobility in patients after hip fracture surgery, explaining 61.8% of the variance (R2 = 0.618; F = 36.598; p <0.001). The study's results provide valuable insights for nurses to target these modifiable factors to enhance patients' mobility. However, it is essential to note that patients with comorbidity and poor cognitive function may face difficulty maintaining mobility. Nurses should be attentive to these patients and provide appropriate management. Additionally, early rehabilitation should be initiated promptly to optimize outcomes.

Prevalence of Cognitive Impairment among Elderly in Primary Health Care Centers in Cairo, Egypt

Abstract Background Cognitive impairment (CI) in the elderly is a growing worldwide public health problem. Symptomatic CI is under-diagnosed, even though early detection in dementia care is of great significance and allowing the person to be involved in future care planning. Objectives To measure the prevalence of CI among elderly patients attending primary health care centers in Elsharabya, Egypt and to identify different risk factors associated with CI. Methods A cross-sectional study was performed among 154 elderly using an interview questionnaire including socio-demographic data, Saint – Louis – University – Mental – Status (SLUMS), Test your memory (TYM)) and General practitioner Assessment of Cognition (GPCOG) questionnaires. Results 51.3% of the studied elderly suffered from mild CI compared to 32.5% suffered from marked CI by SLUM. 68.8% suffered from CI by TYM. 83.3% and 13.0% of them were classified as CI by patient assessment and caregiver interview of GPCOG respectively. The most significant factors associated with CI were being older, non-married, and low educational levels. Conclusions and Recommendations The prevalence of CI is high among the studied elderly. Early identification of CI is important to delay the progression to Alzheimer’s disease and achieve a better quality of life.

Screening for Dementia in Audiology Clinics – Advantages, Pitfalls, and Recommendations

Over the age of 65 years, one in four people has hearing impairment while one in ten people has dementia. Because of common comorbidity of hearing loss with dementia, some advocate routine cognitive screening to identify audiology patients with dementia. 1,2 Identifying patients with dementia may inform provision of additional person-centred adaptations for hearing assessment, selection of amplification devices, support with device use and long-term care planning. 3www.shutterstock.com.We recently surveyed UK audiologists in relation to working with patients with dementia. 4 Audiologists reported being aware that dementia was common among their adult patients but were not aware of appropriate cognitive screening tools or felt they have the expertise to administer them. UK audiologists reported not knowing how to use the results of cognitive screening in relation to hearing rehabilitation or knowing of referral pathways for dementia. IDENTIFYING PATIENTS WITH DEMENTIA Symptoms of dementia are much like the symptoms of hearing impairment; comprehension difficulties, repeating questions, difficulty following conversations, and social isolation. Some people with dementia are very good at compensating for cognitive difficulties, such that audiologists may not be able to reliably identify whether the person has dementia based on their clinical impression. Case history or referral information could be used to identify patients with dementia. Unfortunately, referral sources might not mention dementia, or dementia may have a recent onset. Further, up to 40% of people with dementia never receive a formal diagnosis. 5 Among those who are diagnosed, the average time between noticing symptoms and specialist diagnosis of dementia is four years. 6 And 20% of people who have been diagnosed with dementia do not report having dementia when asked. 7 Because of the limitations of identifying patients with dementia based on clinical impression, referral information and case history, audiologists may choose to use cognitive screening tools to identify patients with dementia and to distinguish between hearing issues and cognitive problems. ACCEPTABILITY TO PATIENTS The audiologists in our survey mostly reported they thought cognitive screening would be acceptable to patients. 4 However, some patients may not agree to a cognitive assessment that they could perceive as being intrusive and threatening. Audiologists should be appropriately trained in explaining the purpose of cognitive screening and discussing the results. 1,2 Instead of calling it ‘dementia screening,’ audiologists should explain that the cognitive screening is to rule out other issues that may cause communication difficulties. COGNITIVE SCREENING TOOLS Various screening tools are available (e.g. the Montreal Cognitive Assessment 8 (MoCA) or the Mini Mental State Examination 9 (MMSE)). These tests are designed to briefly assess several aspects of cognition, to be sensitive to cognitive difficulties across various types of dementia. Alzheimer’s disease is the most common form of dementia, characterized by memory problems. Language, behavior or other cognitive abilities are first affected in atypical forms of Alzheimer’s disease or other types of dementia (e.g. frontotemporal dementia). Cognitive screening tools are designed to detect pronounced impairment, not to detect subtle changes in specific cognitive abilities, or to discriminate between types of dementia. So, if a patient performs poorly on a cognitive screening tool, then hearing assessment will probably be affected. Appropriate training and expertise are needed to administer, interpret, and discuss the results of cognitive screening with patients. Performance on cognitive screening tools is impacted by various factors including, educational level, age, and mood, as well as hearing and vision impairment. Unfortunately, most cognitive screening tests rely on the patient having good hearing. Hearing impairment affects performance on screening and other cognitive tests. 10,11 People have tried to adapt cognitive screening tools for people with hearing impairment, but the reliability of these adapted tools for identifying cognitive impairment has typically not been established 12 or is inadequate. 13 A version of the MoCA has been adapted and validated for people with hearing impairment 14,15 and is freely available (mocacognition.com). Although the MoCA is free, users must register and either complete online training (at small cost) or be supervised by an appropriately qualified person (e.g., a clinical neuropsychologist). A tool that avoids the confound with hearing loss and does not require training or supervision is the informant interview version of the General Practitioner assessment of cognition (http://gpcog.com.au/index/informant-interview; GPcog). This tool is completed by the patient’s partner (or anyone who has known the patient for several years), with the informant asked about changes in the patient’s cognition over time. Poor performance on a cognitive screening tool indicates that the patient needs further detailed cognitive assessment. A full cognitive evaluation involves detailed assessment of multiple cognitive domains (e.g., attention, perception, executive functions, memory, language, social cognition). Full cognitive evaluations are time consuming and expensive, and there are wait lists to see expert clinicians. Carers of people living with dementia report that not having a diagnosis is distressing and that a clear diagnosis made it easier to manage because they could then receive advice and support. However, lack of evidence for the benefits for carers or patients with earlier detection of dementia and the potential for causing distress means that routine screening of asymptomatic adults for dementia is currently not advised by national health organizations. 16,17 CONCLUSION AND RECOMMENDATIONS To enable person-centered care, it is useful to know if your patient is living with dementia. Identifying those with dementia is appropriately done via case history taking with the patient and their care partner and/or referral information. We do not recommend routine cognitive screening in audiology clinics, following national guidance against routine screening for dementia among asymptomatic adults. 16,17 Cognitive screening tests should only be used with specific patients in cases where the audiologist needs to check whether a cognitive issue may contribute to a patient’s communication difficulties. If audiologists do cognitive screening, they must ensure that they allow sufficient additional time to do cognitive screening, discuss the results, and address questions from the patient. Audiologists must ensure that appropriate referral pathways to memory clinics are in place, including when and where to refer and what information is included in the referral. 18 Audiologists must also ensure that they have proper training in administering and interpreting an appropriate test (e.g., the MoCA-H or the GPcog informant version) and are prepared and able to discuss the results with the patient. 1,2 Recommendations for providing person-centred hearing care are available to optimize quality of life for people living with dementia and hearing impairment. 3,19

Cognition and cardiovascular comorbidities among older adults in primary care in West India.

Cardiovascular risk factors (e.g., diabetes and hypertension) are comorbidities associated with cognitive impairment. The present study was planned to study the relationship between cardiovascular risk factors and cognitive impairment using General Practitioner assessment of Cognition (GPCOG) scale, which is easy to use scale in the primary care. A total of 350 older adults (mean age=66.71 ± 6.53 years; M:F = 220:130) among 3000 who reported to the primary care center in West India were screened. Cardiovascular risk factors were assessed based on written medical records. GPCOG was used for cognitive screening of those over the age of 60 with subjective memory complaints. Frequency of cardiovascular (CV) risk factors in those with cognitive impairment was 46.2% (n = 162/350) and 29% (101/350) in those without cognitive impairment. A Chi-square test of proportion showed values to be statistically significantly different (Chi-square value = 22.04; P =< 0.001; 95% confidence interval [CI] = 10.0463-24.1076%). Odds ratio was found to be 1.6 (95% CI =2-2.1; P =< 0.05). A higher CV risk factors were observed among those with cognitive impairment compared to those cognitively normal older adults in the primary care.

A new model for general practice-led, regional, community-based, memory clinics

BackgroundDementia is a major international health issue with high impact on the patient, relatives, and broader society. Routine screening for dementia is limited, despite known benefit of early detection and intervention on quality of care and patient outcomes. Screening is particularly limited in rural and regional areas, despite high burden and projected growth of dementia in these populations. The current study aimed to implement a new general practitioner (GP) led, multidisciplinary, model of care providing dementia detection and referral pathway to a community-based specialist clinic across six regional general practices.MethodsCross-sectional analysis of dementia screening and referral characteristics in the St Anthony Family Medical Practices group based in the regional area of Loddon-Mallee, Victoria. Data were collected on demographics and relevant medical history. Cognitive state was assessed using the Mini-Mental State Examination (MMSE), GP Assessment of Cognition (GPCog), and Geriatric Depression Scale (GDS). Referrals and referral outcomes were recorded for geriatrician, psycho-geriatrician, or both.ResultsEight hundred and eighteenth patients over 65 years were screened, accounting for approximately 24.2% of 65 and over presentations for the practice network. Of those screened, 68.9% were indicated for referral and 30.3% of these were successfully referred. Of the indicated patients who received referrals, 34.2% declined. Many who declined referral had intermediate scores on the cognitive assessments utilized.ConclusionStandardised models of care, integrated within community services, are necessary to improve access to early detection, referral and quality management of dementia. The St Anthony Memory Service model will be invaluable in informing future service development, and in particular the development of services for people living with dementia in rural and regional communities.

Community Screening of Probable Dementia at Primary Care Center in Western India: A Pilot Project.

Introduction  Timely detecting dementia is an important goal of clinicians and public health professionals alike for better management and prevention of complications. Community screening of dementia could be a powerful strategy. Facilities for dementia screening at primary care level are virtually nonexistent and are a prominent implementation gap. Hence, a study was done to assess the feasibility of dementia screening at primary care using General Practitioner Assessment of Cognition (GPCoG) scale among older adults with subjective memory complaints. It was further aimed to assess the frequency of cardiovascular risk factors in those who met screening criteria for cognitive impairment. Materials and Methods  Older adults coming to three urban primary care centers in western India for screening of noncommunicable diseases such as diabetes and hypertension (opportunistic screening) with subjective memory complaints were enrolled and screened for dementia using GPCoG. A Mini-Mental State Examination (MMSE) was done in patients who came alone for referral purpose in case the score levels in GPCoG examination met cutoff limits for informant interview. Written medical records were examined to assess status of comorbid vascular risk factors such as diabetes, hypertension, coronary artery disease, and cerebrovascular accidents. Results  A total of 350 older adults (M:F = 276: 74; mean age ± 68 ± 6.7 years) were screened out of 3,000 older adults who reported during the study period. There were 161 older adults with GPCoG score less than or equal to 5 (56.14%) and 149 subjects with MMSE less than or equal to 24 indicating significant cognitive impairment (42.5%). There were very few ( n  = 11, 3.14%) out of 350 people who came with caregivers; hence, MMSE was done along with for referral to healthcare providers. A total of 142 had comorbid diabetes/and or hypertension (40.5%). A total of 86 had diabetes alone (24.5%) and a total of 128 had hypertension (36.5%). Conclusion  Current study results indicate that using a simple screening tool such as GPCoG, community screening of probable dementia, is feasible in primary care settings, as is indicated by significant yield of probable dementia cases (42.5%). These cases can be referred to appropriate centers for further workup, confirmation of diagnosis, and treatment. Also, detection of comorbid cardiovascular conditions, for example, diabetes and hypertension, that can be managed along with cognitive impairment/dementia for potential prevention/further deterioration, which can strengthen noncommunicable disease screening.

Delirium risk factors in hospitalized patient: a comprehensive evaluation of underlying diseases and medications in different wards of a large Urban Hospital Center in Iran

BackgroundDelirium is a neurobehavioral syndrome, which is characterized by a fluctuation of mental status, disorientation, confusion and inappropriate behavior, and it is prevalent among hospitalized patients. Recognizing modifiable risk factors of delirium is the key point for improving our preventive strategies and restraining its devastating consequences. This study aimed to identify and investigate various factors predisposing hospitalized patients to develop delirium, focusing mostly on underlying diseases and medications.MethodIn a prospective, observational trial, we investigated 220 patients who had been admitted to the internal, emergency, surgery and hematology-oncology departments. We employed the Confusion Assessment Method (CAM) questionnaire, The Richmond Agitation Sedation Scale (RASS), the General Practitioner Assessment of Cognition (GPCOG), demographic questionnaire, patient interviews and medical records. Multivariate logistic regression models were used to analyze the predictive value of medications and underlying diseases for daily transition to delirium.; demographics were analyzed using univariate analysis to identify those independently associated with delirium.ResultsTwo hundred twenty patients were enrolled; the emergency department had the most incident delirium (31.3%), and the surgery section had the least (2.4%); delirium was significantly correlated with older ages and sleep disturbance. Among multiple underlying diseases and the medications evaluated in this study, we found that a history of dementia, neurological diseases and malignancies increases the odds of transition to delirium and the use of anticoagulants decreases the incident delirium.ConclusionApproximately 1 out of 10 overall patients developed delirium; It is important to evaluate underlying diseases and medications more thoroughly in hospitalized patients to assess the risk of delirium.

Improving Diagnosis of Functional Cognitive Impairment in Younger Adults in Primary Care: Validation of Cognitive Screening Tools and the 4-Item Geriatric Depression Scale.

Cognitive decline is classically attributed to organic causes such as dementia; however, depression can play a role in cognitive decline. To evaluate cognitive screening tools and the 4-item Geriatric Depression Scale (GDS-4) for use in primary care to distinguish cognitive decline secondary to depression. Clinical data collected over 2.5 years for assessed patients in a secondary clinical service for younger adults. Cognitive screening tools (General Practitioner Assessment of Cognition, Addenbrooke's Cognitive Examination-III, Rowland Universal Dementia Assessment Scale, Salzburg Dementia Test Prediction) and GDS-4 were analyzed for their accuracy to differentiate patients with cognitive decline due to depression from those with subjective cognitive complaints. 180 young adults seen in a memory clinic setting (< 65 years) were included. These individuals either had a diagnosis of depression (n = 46) or no cognitive impairment on assessment (n = 134) despite having subjective cognitive complaints. All used cognitive tools had poor accuracy in differentiating cognitive decline secondary to depression from subjective cognitive complaints. The GDS-4 alone, however, was able to differentiate with high accuracy (AUC = 0.818) individuals who had cognitive problems secondary to depression. Cognitive screening tools used alone are ineffective in discriminating cognitive decline secondary to depression. Incorporating the GDS-4 into the screening process by primary practitioners could facilitate early identification and treatment of depression in younger people, avoiding unnecessary referrals memory services.

Linguistic and cultural adaptation of the Russian version of general practitioner assessment of cognition questionnaire ― GPCOG in elderly and senile patients at the primary care level

Russian version of the General Practitioner's Assessment of Cognition (GPCOG) questionnaire-test was adapted in accordance with modern international recommendations, including the procedure of its consecutive translations, testing of the Russian version of the questionnaire as part of interviewing geriatric patients and their relatives, as well as expert evaluation of the Russian version by specialists and decentering. The testing procedure involved 8 geriatric patients (age 61-77 years, men/women - 3/5), as well as their relatives/other close persons; 8 specialists participated in the questionnaire (age 24-52 years, all women). Based on the data of interviewing patients and their relatives, an acceptable indicator of the external validity of the Russian version of the tool was established, according to the results of the questionnaire of specialists, its substantive validity was confirmed. The results of testing the GPCOG questionnaire-test in the focus group of patients and the questionnaire of specialists made it possible to make changes for two tasks at the decentering stage, which made it possible to improve the equivalence of the instrument to its original version, taking into account the ethno-linguistic characteristics of the domestic population. In the process of linguistic and cultural adaptation, the final version of the GPCOG questionnaire-test In Russian was formed, equivalent to the original and corresponding to the ethnolinguistic features of the population. The use of GPCOG in domestic geriatric practice and scientific research is possible after testing the instrument in a population of elderly and senile patients with the participation of primary care specialists and evaluating the psychometric properties of the instrument - reliability, sensitivity and specificity within the validation procedure.

Burden and correlates of cognitive impairment among hypertensive patients in Tanzania: a cross-sectional study

BackgroundThe evolution of cognitive impairment of vascular origin is increasingly becoming a prominent health threat particularly in this era where hypertension is the leading contributor of global disease burden and overall health loss. Hypertension is associated with the alteration of the cerebral microcirculation coupled by unfavorable vascular remodeling with consequential slowing of mental processing speed, reduced abstract reasoning, loss of linguistic abilities, and attention and memory deficits. Owing to the rapidly rising burden of hypertension in Tanzania, we sought to assess the prevalence and correlates of cognitive impairment among hypertensive patients attending a tertiary cardiovascular hospital in Tanzania.MethodologyA hospital-based cross-sectional study was conducted at Jakaya Kikwete Cardiac Institute, a tertiary care public teaching hospital in Dar es Salaam, Tanzania between March 2020 and February 2021. A consecutive sampling method was utilized to recruit consented hypertensive outpatients during their scheduled clinic visit. General Practitioner Assessment of Cognition (GPCOG) Score was utilized in the assessment of cognitive functions. All statistical analyses utilized STATA v11.0 software. Pearson Chi square and Student’s T-test were used to compare categorical and continuous variables respectively. Logistic regression analyses were used to assess for factors associated with cognitive impairment. Odd ratios with 95% confidence intervals and p-values are reported. All tests were 2-sided and p < 0.05 was used to denote a statistical significance.ResultsA total of 1201 hypertensive patients were enrolled in this study. The mean age was 58.1 years and females constituted nearly two-thirds of the study population. About three quarters had excess body weight, 16.6% had diabetes, 7.7% had history of stroke, 5.7% had heart failure, 16.7% had renal dysfunction, 53.7% had anemia, 27.7% had hypertriglyceridemia, 38.5% had elevated LDL, and 2.4% were HIV-infected. Nearly two-thirds of participants had uncontrolled blood pressure and 8.7% had orthostatic hypotension. Overall, 524 (43.6%) of participants had cognitive impairment. During bivariate analysis in a logistic regression model of 16 characteristics, 14 parameters showed association with cognitive functions. However, after controlling for confounders, multivariate analysis revealed ≤primary education (OR 3.5, 95%CI 2.4–5.2, p < 0.001), unemployed state (OR 1.7, 95%CI 1.2–2.6, p < 0.01), rural habitation (OR 1.8, 95%CI 1.1–2.9, p = 0.01) and renal dysfunction (OR 1.7, 95%CI 1.0–2.7, p = 0.04) to have independent association with cognitive impairment.ConclusionThis present study underscore that cognitive decline is considerably prevalent among individuals with systemic hypertension. In view of this, it is pivotal to incorporate cognitive assessment in routine evaluation of hypertensive patients.

Diagnostic accuracy of dementia screening tools in the Chinese population: a systematic review and meta-analysis of 167 diagnostic studies.

The rate of undetected dementia is high in China. However, the performance of dementia screening tools may differ in the Chinese population due to the lower education level and cultural diversity. This study aimed to evaluate the diagnostic accuracy of dementia screening tools in the Chinese population. Eleven electronic databases were searched for studies evaluating the diagnostic accuracy of dementia screening tools in older Chinese adults. The overall diagnostic accuracy was estimated using bivariate random-effects models, and the area under the summary receiver operating characteristic curve was presented. One hundred sixty-seven studies including 81 screening tools were identified. Only 134 studies qualified for the meta-analysis. The Mini-Mental State Examination (MMSE) was the most commonly studied tool, with a combined sensitivity (SENS) and specificity (SPEC) of 0.87 (95%CI 0.85-0.90) and 0.89 (95%CI 0.86-0.91), respectively. The Addenbrooke's Cognitive Examination-Revised (ACE-R) (SENS: 0.96, 95%CI 0.89-0.99; SPEC: 0.96, 95%CI 0.89-0.98) and Montreal Cognitive Assessment (MoCA) (SENS: 0.93, 95%CI 0.88-0.96; SPEC: 0.90, 95%CI 0.86-0.93) showed the highest performance. The General Practitioner Assessment of Cognition (GPCOG), Hasegawa's Dementia Scale and Cognitive Abilities Screening Instrument had performances comparable to that of the MMSE. The cut-off scores ranged widely across studies, especially for the MMSE (range: 15-27) and MoCA (range: 14-26). A number of dementia screening tools were validated in the Chinese population after cultural and linguistical adaptations. The ACE-R and MoCA had the best diagnostic accuracy, whereas the GPCOG, with an administration time < 5minutes, could be considered as a rapid screening tool.

Validity and reliability of the Persian version of general practitioner assessment of cognition (P-GPCOG)

ABSTRACTObjectives: The study aimed to examine the validity, reliability, and practicality of the Persian version of the General Practitioner Assessment of Cognition (P-GPCOG) as a brief, efficient cognitive assessment instrument in Iranian older adults.Method: The sample comprised 151 community-dwelling older adults and 79 nursing home residents (aged ≥60 years). The English GPCOG was translated, back-translated, and revised to prepare the final P-GPCOG. The Abbreviated Mental Test score (AMTs) and the Depression in Old Age Scale (DIA-S) were administered to the two different samples to establish the convergent and discriminant validity of the P-GPCOG.Results: The mean age of the sample was 70.67 (SD = 9.51); 57.4% were male. The mean P-GPCOG scores for the total, cognitive and informant subscales were 7.67 (SD = 4.59), 4.18 (SD = 2.73), and 3.49 (SD = 2.24), respectively. Cognitive (P < 0.001), informant (P < 0.001) and total scores (P < 0.001) differed significantly between community-dwelling participants and nursing home residents. Worse cognitive performance on the P-GPCOG correlated significantly with worse scores on the AMTs (r = 0.61, P < 0.001) and less so with depressive symptoms as measured with the DIA-S (r = −0.20, P < 0.05). Cronbach's alpha for the P-GPCOG cognitive and informant subscales were 0.90 and 0.83 respectively, indicating a high degree of internal consistency and homogeneity between items. The test-retest correlation for the total P-GPCOG score was 0.82 in 30 participants after 19 days. P-GPCOG cognitive scores correlated significantly with education.Conclusion: The P-GPCOG displayed strong psychometric properties, offering healthcare professionals a quick and efficient cognitive instrument for older Persian speakers. As with other cognitive assessment tools, the P-GPCOG cognitive score is affected by a person's level of education.

To Investigate Role of Glycosylated Hemoglobin (Hba1c) as a Biomarker for Prediction of Dementia and Cognitive Dysfunction in Type 2 Diabetic Patients

Introduction: Diabetes Mellitus is one the major disease burden globally. One of the significant complications of the uncontrolled Diabetics is Cognitive dysfunction and Dementia. In this study we laid focus on the Evaluation of HbA1C as a Biomarker to predict Dementia and Cognitive Dysfunction in Type 2 Diabetic Mellitus. Aim of the study: A pilot study to investigate HbA1C as a Biomarker for prediction of Dementia and Cognitive Dysfunction in Type 2 Diabetic Mellitus in a Hospital Setting. Methods and results: A prevalence study in which 60 subjects (n=30 Type 2 Diabetics; n=30 non Diabetic) were enrolled. In this study HbA1C values were correlated with that of individual memory and cognition batteries* score. The range of the HbA1C values was 7.1 to 13.3. The mean values of HbA1C in the Diabetic group (n=30) was found to be 9.19.The corresponding values of Pearson’s Correlation “r” in the diabetic group of the w.r.t. various Cognitive batteries were: General Practitioner Assessment of Cognition (GPCOG)=-0.53; Attendant Informant Tool (AI)=-0.43; Memory Impairment Screen (MIS)=-0.37; Negative values of the Pearson’s Correlation “r” indicates that lower the respective battery score, poorer is the cognitive function. In the Diabetic group GPCOG, AI and MIS were found to be significantly correlated with HBA1C. Similarly, in the non- Diabetic group (n=30), no significant Dementia and Cognitive Impairment was recorded when same group of Cognitive Batteries were administered. Conclusion: It is quite evident from the results that HbA1C as biomarker has a great potential to predict Dementia and Cognitive decline in uncontrolled Diabetes. However, the study needs to be conducted on a larger scale along with comparative analysis with tools like Functional MRI and other standard biomarkers.

Cognitive screening tools for primary care settings: examining the ‘Test Your Memory’ and ‘General Practitioner assessment of Cognition’ tools in a rural aging population in Greece

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.

The comparative diagnostic accuracy of the Mini Mental State Examination (MMSE) and the General Practitioner assessment of Cognition (GPCOG) for identifying dementia in primary care: a systematic review protocol

BackgroundImproved dementia identification is a global health priority, and general practitioners (GPs) are often the first point of contact for people with concerns about their cognition. However, GPs often express uncertainty in using assessment tools and the evidence based on which tests are most accurate in identifying dementia is unclear. In particular, there is little certainty around how the accuracy of available brief cognitive assessments compares within a clinical family practice setting.Grounded in existing brief cognitive assessment evidence, we will compare the diagnostic test accuracy of the Mini Mental State Examination (MMSE) to the General Practitioner Assessment of Cognition (GPCOG) against the best available reference standard when used within a family practice setting.MethodsWe will employ robust systematic review methods to assess studies of diagnostic accuracy where both the MMSE and GPCOG have been evaluated as direct comparisons, i.e. within the same study population. This approach will enable us to minimise between-study heterogeneity, to eliminate the risk of bias due to confounding and increase the opportunity to make clinically useful and useable comparisons of diagnostic accuracy across both the MMSE and GPCOG. This systematic review will be conducted using a pragmatic search strategy, refining searches that build upon studies identified as part of our overview of systematic reviews of the diagnostic accuracy of brief cognitive assessments for identifying dementia in primary care.DiscussionThrough this systematic review, we aim to improve existing evidence on how the diagnostic accuracy of MMSE and GPCOG compares when used to identify dementia within the family practice setting. We also aim to make clinical practice recommendations based upon the variations in diagnostic accuracy identified between the MMSE and GPCOG.

Cost effectiveness of using cognitive screening tests for detecting dementia and mild cognitive impairment in primary care.

We estimated the cost effectiveness of different cognitive screening tests for use by General Practitioners (GPs) to detect cognitive impairment in England. A patient-level cost-effectiveness model was developed using a simulated cohort that represents the elderly population in England (65 years and older). Each patient was followed over a lifetime period. Data from published sources were used to populate the model. The costs include government funded health and social care, private social care and informal care. Patient health benefit was measured and valued in Quality Adjusted Life Years (QALYs). Base-case analyses found that adopting any of the three cognitive tests (Mini-Mental State Examination, 6-Item Cognitive Impairment Test or GPCOG (General Practitioner Assessment of Cognition)) delivered more QALYs for patients over their lifetime and made savings across sectors including healthcare, social care and informal care compared with GP unassisted judgement. The benefits were due to early access to medications. Among the three cognitive tests, adopting the GPCOG was considered the most cost-effective option with the highest Incremental Net Benefit (INB) at the threshold of £30 000 per QALY from both the National Health Service and Personal Social Service (NHS PSS) perspective (£195 034 per 1000 patients) and the broader perspective that includes private social care and informal care (£196 251 per 1000 patients). Uncertainty was assessed in both deterministic and probabilistic sensitivity analyses. Our analyses indicate that the use of any of the three cognitive tests could be considered a cost-effective strategy compared with GP unassisted judgement. The most cost-effective option in the base-case was the GPCOG. Copyright © 2016 John Wiley & Sons, Ltd.