Here's three easy pieces for dementia screening.
The three appear to be the best tools for routine screening in the primary care setting, according to data presented at an international conference sponsored by the Alzheimer's Association.
"The GP is the first point of contact that people go to when they're worried about their memory," said Henry Brodaty, M.D., head of the memory disorders clinic at Prince of Wales Hospital in Sydney, Australia. Primary care physicians are more accessible to most people than are specialists, so they are in the best position to identify dementia early.
Still, primary care physicians miss as much as 90% of mild to moderate dementia cases, he said.
To determine which screening instruments were best suited for use in primary care, Dr. Brodaty and his colleagues searched major medical databases for studies assessing dementia screening instruments. The analysis included 16 instruments; the Memory Impairment Screen, the Mini-Cog, and the General Practitioner Assessment of Cognition were the best tools for routine screening, based on validity, accuracy, and time to administer/ease of use.
All three have been validated in a community sample, a population sample, or a general practice sample. The instruments are simple to use and can be administered in 5 minutes or less. They also have negative predictive values no greater than that of the Mini-Mental State Examination and positive predictive values no less than that of the MMSE. All three tools have sensitivities and specificities greater than 80%.
The General Practitioner Assessment of Cognition was developed by Dr. Brodaty and a colleague. The test for patients has five components, including questions about the current date and a news event, a clock drawing task, and a brief verbal recall task, with a total possible score of nine. Those who score below five are considered cognitively impaired. For patients who score eight or less, input is needed from a knowledgeable informant; six questions about the patient's memory and daily living skills are included for the informant.
The Mini-Cog uses a three-item recall test and a clock-drawing test. If the patient can recall all three items, he or she is considered not demented. For those who can recall one or two items, additional information from the clock-drawing test is needed. Those who can recall no items are considered demented. In the Memory Impairment Screen, the patient is given the names of items in four different categories. After a delay, the patient is asked to name the item in each category. The score is calculated as two times the number of items freely recalled plus the number of items recalled with help--a range of 0-8 points. A score of 4 or less indicates possible dementia.
One of the biggest factors in finding the best tools for primary care screening was time of administration, Dr. Brodaty said. The average consultation with a primary care physician lasts 6-12 minutes. "A 10-minute screen takes too long for most GPs," but more than 90% of primary care physicians would use a brief (less than 5 minutes) simple screening tool to evaluate patients for signs of dementia, he said.
The Mini-Cog takes about 3 minutes to administer. The patient portion of the General Practitioner Assessment of Cognition takes 4 minutes; the informant portion takes 2 minutes. The Memory Impairment Screen takes about 4 minutes.
The researchers also surveyed general practitioners in the Sydney area about these three cognitive screening tools. Only 80 out of 722 physicians who were sent the questionnaire responded. Of that group, 85% said that the General Practitioner Assessment of Cognition and the Mini-Cog were easy to use, while 53% said that the Memory Impairment Screen was easy to use.
BY KERRI WACHTER
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|Title Annotation:||Geriatric Medicine|
|Publication:||Internal Medicine News|
|Date:||Oct 1, 2005|
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