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O1‐07‐02: RISK STRATIFICATION AND COGNITIVE SCREENING: PREPARING FOR ALZHEIMER'S DISEASE‐MODIFYING MEDICATIONS
Author(s) -
Mansbach William E.,
Mace Ryan A.,
Tanner Melissa
Publication year - 2018
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.2018.06.2367
Subject(s) - disease , cognition , medicine , health care , gerontology , construct validity , cognitive assessment system , cognitive test , cognitive decline , dementia , cognitive impairment , clinical psychology , psychometrics , psychiatry , pathology , economics , economic growth
(n1⁄41518). Those with missing predictors were excluded (n1⁄492; final n1⁄41426). Predictors were age, years of education, stroke, diabetes, depressive symptoms, difficulty with individual activities of daily living (IADL), and body mass index (BMI). The DSI point system was applied: age 65 years is 0 points, 1 point per year for ages 66 to 79 years; <12 years of education, 9 points; stroke, 6 points; diabetes, 3 points; depression, 6 points; IADL difficulty, 10 points; and BMI<18.5, 8 points. Per the DSI, a cut point of 22 points stratified subjects into highand low-risk groups. Sensitivity, specificity, and positive (PPV) and negative predictive values (NPV) of the DSI were calculated. Results:The DSI correctly identified 21/278 high-risk subjects (PPV1⁄47.6%) and 1141/1148 lowrisk subjects (NPV1⁄497.6%). Sensitivity was 43.8% and specificity was 81.3%. Conclusions:Although only 8% of DSI-classified highrisk patients developed dementia over 6 years, 98% of individuals classified as low-risk, and, therefore, not in need of cognitive screening, remained dementia-free. We validated that physicians can risk-stratify patients using the DSI and do not need to recommend low-risk adults for cognitive screening. This would save, on average, $250/cognitive screen in addition to other timeand costsavings for patients, physicians, Medicare, and healthcare systems.