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Case‐finding for cognitive impairment among people with Type 2 diabetes in primary care using the Test Your Memory and Self‐Administered Gerocognitive Examination questionnaires: the Cog‐ ID study
Author(s) -
Koekkoek P. S.,
Janssen J.,
Kooistra M.,
Biesbroek J. M.,
Groeneveld O.,
Berg E.,
Kappelle L. J.,
Biessels G. J.,
Rutten G. E. H. M.
Publication year - 2016
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.12874
Subject(s) - medicine , type 2 diabetes , test (biology) , primary care , cognitive impairment , gerontology , cog , diabetes mellitus , cognition , family medicine , psychiatry , endocrinology , paleontology , artificial intelligence , computer science , biology
Aim To evaluate two cognitive tests for case‐finding for cognitive impairment in older patients with Type 2 diabetes. Methods Of 1243 invited patients with Type 2 diabetes, aged ≥70 years, 228 participated in a prospective cohort study. Exclusion criteria were: diagnosis of dementia; previous investigation at a memory clinic; and inability to write or read. Patients first filled out two self‐administered cognitive tests (Test Your Memory and Self‐Administered Gerocognitive Examination). Secondly, a general practitioner, blinded to Test Your Memory and Self‐Administered Gerocognitive Examination scores, performed a structured evaluation using the Mini‐Mental State Examination. Subsequently, patients suspected of cognitive impairment (on either the cognitive tests or general practitioner evaluation) and a random sample of 30% of patients not suspected of cognitive impairment were evaluated at a memory clinic. Diagnostic accuracy and area under the curve were determined for the Test Your Memory, Self‐Administered Gerocognitive Examination and general practitioner evaluation compared with a memory clinic evaluation to detect cognitive impairment (mild cognitive impairment or dementia). Results A total of 44 participants were diagnosed with cognitive impairment. The Test Your Memory and Self‐Administered Gerocognitive Examination questionnaires had negative predictive values of 81 and 85%, respectively. Positive predictive values were 39 and 40%, respectively. The general practitioner evaluation had a negative predictive value of 83% and positive predictive value of 64%. The area under the curve was ~0.70 for all tests. Conclusions Both the tests evaluated in the present study can easily be used in case‐finding strategies for cognitive impairment in patients with Type 2 diabetes in primary care. The Self‐Administered Gerocognitive Examination had the best diagnostic accuracy and therefore we would have a slight preference for this test. Applying the Self‐Administered Gerocognitive Examination would considerably reduce the number of patients in whom the general practitioner needs to evaluate cognitive functioning to tailor diabetes treatment.