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O2–03–07: Primary care screen for early dementia
Author(s) -
Grober Ellen,
Lipton Richard B.,
Hall Charles B.
Publication year - 2007
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2007.04.032
Subject(s) - mcnemar's test , dementia , medicine , gold standard (test) , primary care , cutoff , audiology , test (biology) , disease , gerontology , family medicine , statistics , paleontology , physics , mathematics , quantum mechanics , biology
Background: Accurate, efficient and cost-effective procedures are lacking for identifying early AD in educationally and racially diverse primary care settings where misclassification rates using the Mini Mental Status Exam (MMSE) are high. This is a major barrier to initiating early interventions in primary care where most seniors receive routine medical care. We have developed a two-stage screening strategy for identifying early dementia. The first or Rapid Screen, applied to all patients over the age of 65, consists of the Memory Impairment Screen and Animal Fluency. The second or Diagnostic Stage, applied to those patients who screen positively in the Rapid Screen, is accomplished with the Free and Cued Selective Reminding Test. This strategy which we call the Alzheimer’s Disease Screen for Primary Care (ADS-PC) had high sensitivity and specificity for identifying early dementia and better operating characteristics for identifying AD. Objective: Herein, we compared the sensitivity and specificity of the ADS-PC with the MMSE against an independent clinically assessed gold standard diagnosis of 300 educationally and racially diverse primary care patients including 50 patients with early dementia (CDR 0.5). Methods: The cutoff on the MMSE was manipulated to achieve the same level of sensitivity or specificity as the ADS-PC depending upon whether classification accuracy for cases or noncases was being compared. Once equated, differences in the sensitivities or specificities of the two strategies were evaluated with the McNemar test. Results: By using the standard cutoff of 24 on the MMSE, the specificity of both tests was the same, (.90), but the sensitivities were significantly different (.74 for the ADS-PC and .56 for the MMSE). The MMSE failed to identify four times as many cases of dementia as the ADS-PC at equivalently high levels of specificity. When the sensitivities of both tests were equated, the specificities differed significantly. The MMSE misclassified five times as many noncases as the ADS-PC. This pattern of significantly higher sensitivity and specificity for the ADS-PC compared to the MMSE was repeated in the results by race. Conclusion: The ADS-PC outperformed the MMSE in identifying early dementia in a racially and educationally diverse primary care cohort.