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Screening for Cognitive Impairment: Comparing the Performance of Four Instruments in Primary Care
Author(s) -
Holsinger Tracey,
Plassman Brenda L.,
Stechuchak Karen M.,
Burke James R.,
Coffman Cynthia J.,
Williams John W.
Publication year - 2012
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2012.03967.x
Subject(s) - dementia , medicine , cognitive impairment , primary care , cognitive test , cognition , odds ratio , memory clinic , gerontology , psychiatry , family medicine , disease
Objectives To determine whether brief cognitive screening tests perform as well as a longer screening test in diagnosis of cognitive impairment, no dementia ( CIND ) or dementia. Design A cross‐sectional comparison of cognitive screening tests to an independent criterion standard evaluation using D iagnostic and S tatistical M anual of M ental D isorders, F ourth E dition ( DSM ‐ IV ) criteria. Performance of the cognitive screening tests for identifying dementia, and separately for identifying dementia or CIND , was characterized using sensitivity, specificity, likelihood ratios, and diagnostic odds ratios. Setting Three D epartment of V eterans A ffairs primary care clinics. Participants Of 826 independently living veterans aged 65 and older without a prior diagnosis of dementia, 639 participated and 630 were assigned a research diagnosis. Measurements Screening tests included the modified M ini‐ M ental S tate E xamination (3 MS ; average time to administer, 17 minutes) and three brief instruments: the M emory I mpairment S creen ( MIS ; 4 minutes), the M ini‐ C og (3 minutes), and a novel two‐item functional memory screen ( MF ‐2; 1.5 minutes). Results Participants were aged 74.8 on average and were mostly white or black. They were mostly male (92.9%) and had been prescribed a mean of 7.7 medications for chronic conditions. The prevalence of dementia and CIND was 3.3% and 39.2%, respectively. Sensitivity and specificity for dementia were 86% and 79% for the 3 MS , 76% and 73% for the M ini‐ C og, 43% and 93% for the MIS , and 38% and 87% for the MF ‐2, respectively. Conclusion In individuals without a prior diagnosis of cognitive impairment, the prevalence of dementia was low, but the prevalence of CIND was high. The 3 MS and M ini‐ C og had reasonable performance characteristics for detecting dementia, but a definitive diagnosis requires additional evaluation.