The Use Of The Cognitive Status Examination In Detecting Cognitive Impairment In Elderly People (original) (raw)
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Yield of a new method to detect cognitive impairment in general practice
International Journal of Geriatric Psychiatry, 2007
Objective To examine whether a new screening method that identified patients with cognitive impairment who needed further examination on the presence of dementia yielded patients who were not detected by their general practitioner (GP), and to identify factors associated with GPs' awareness of patients identified by the screening. Methods Cross-sectional comparison between two methods used to identify dementia symptoms: (1) usual identification of dementia by GPs; (2) a two-stage screening to identify cognitive impairment. The two methods were implemented on the same older general practice population. The study was set in primary care practices in the Netherlands. The participants were 44 GPs and 2,101 general practice patients aged 75þ who lived at home. The following measurements were used: (1) yield of the screening; (2) determinants of GPs' awareness of patients identified by the screening. Results The two-stage screening yielded 117 patients with cognitive impairment who needed further examination; in most cases (n ¼ 82, 70.1%) their GP was unaware of the symptoms. Among patients identified by the screening, GPs' awareness was associated with co-morbidity of chronic diseases [odds ratio (OR) ¼ 3.19; 95% Confidence Interval (CI) ¼ 1.25 to 8.15], depressive symptoms (OR ¼ 0.41; 95% CI ¼ 0.17 to 0.99), and cognitive functioning (per point on the MMSE, OR ¼ 0.88; 95% CI ¼ 0.79 to 0.98). Conclusion A two-stage screening method and increased alertness for cognitive impairment and dementia among patients with depressive symptoms may improve detection rate of dementia in general practice.
Age and Ageing, 2003
Objective: to determine the documentation rate of dementia in primary health care, the clinical characteristics of patients with documented and undocumented dementia, and the diagnostic evaluations made in cognitive impairment. Design: cross-sectional population-based study with a retrospective review of medical history. Setting: primary health care in the municipality of Lieto, Southwestern Finland. Subjects: all the inhabitants aged 64 and over in Lieto. Participation rate 82%, numbers = 1260. Measurements: assessment of dementia according to DSM-IV criteria, and severity according to Clinical Dementia Rating. Possible documentation of dementia and evaluations done were reviewed from primary health care medical records. Results: 112 patients with dementia were found. The sensitivity of the general practitioners' judgment of dementia was 48.2% and the speciWcity 99.6%. The documentation rate of dementia was 73% in severe, 46% in moderate and 33% in mild dementia. A greater proportion of the patients with undocumented dementia were male (P = 0.003), lived at home (P = 0.003), coped better with the instrumental activities of daily living (P = 0.006), had more depression (P = 0.029) and milder dementia (P = 0.005) than patients with documented dementia. Thyroid stimulating hormone was measured in 51% of the patients with suspected memory impairment or dementia, B12 vitamin in 20%, and serum calcium in 18%. Twenty-eight per cent of the patients had been tested for cognitive function, 68% for depressive symptoms, and 88% for social abilities. Forty-two per cent of patients were referred to a specialist, 32% of patients who were over 75 years. Conclusions: less than half of the patients with dementia had their diagnosis documented in primary care medical records. Documentation increased in more advanced dementia. The diagnostic evaluations for reversible causes of dementia were insufWcient in primary care, and they were done at a late phase of cognitive impairment.
Combined instruments for the screening of dementia in older people with low Education
Arquivos de Neuro-Psiquiatria, 2009
Objective: To determine which combination of cognitive tests and informant reports can improve the diagnostic accuracy of dementia screening in low educated older people. Method: Patients with mild to moderate dementia (n=34) according to ICD-10 and DSM-III-R criteria and 59 older controls were assessed with the Mini-Mental State Examination (MMSE) and the Fuld Object Memory Evaluation (FOME). Informants were assessed using the Informant Questionnaire on Cognitive Decline in the Elderly and the Bayer-Activities of Daily Living Scale. Results: The 4 instruments combined with the mixed rule correctly classified 100% and the logistic regression (weighted sum) classified 95.7% of subjects. The weighted sum had a significantly larger ROC area compared to MMSE (p=0.008) and FOME (p=0.023). The specificity of the tested combinations was superior to the MMSE alone (p=0.002). Conclusions: Cognitive tests combined with informant reports can improve the screening of mild to moderate dementia in low educated older people.
La Presse Médicale, 2007
Codex, un test fiable en 3 minutes pour la détection de la démence chez le sujet âgés (étude de validation sur 323 sujets) Contexte > La démence est souvent diagnostiquée au stade modéré ou sévère, ce qui constitue une perte de chance pour les patients. Une détection plus précoce de la démence pourrait être améliorée par des outils faciles à employer en soin primaire. But > Élaborer et valider un test très bref pour la détection de la démence. Méthodes > Étude d'élaboration : chez les patients consécutifs d'une consultation mémoire vus pendant 2 ans, le niveau de l'éducation, les scores et sous-scores du Mini Mental Status Examination (MMSE) et un test d'horloge simplifié (THs) ont été recueillis. Le diagnostic de
Assessment and diagnosis of dementia: a review for primary healthcare professionals
Hong Kong Medical Journal, 2019
Dementia is one of the most costly, disabling diseases associated with ageing, yet it remains underdiagnosed in primary care. In this article, we present the comprehensive approach illustrated with a classical case for diagnosing dementia which can be applied by healthcare professionals in primary care. This diagnostic approach includes history taking and physical examination, cognitive testing, informant interviews, neuropsychological testing, neuroimaging, and the utility of cerebrospinal fluid biomarkers. For the differential diagnosis of cognitive impairment, the differences and similarities among normal ageing, mild cognitive impairment, depression, and delirium are highlighted. As primary care physicians are playing an increasingly prominent role in the caring of elderly patients in an ageing population, their role in the diagnosis of
Dementia and Geriatric Cognitive Disorders Extra
Background/Aim: The screening of dementia in non-Westerners has so far relied on translations and adaptations of reputed instruments. Other efforts focused on developing culturally appropriate tests or tests in touch with new developments in the field. This study presents the rationale behind the construction of a new dementia screening test: the Dementia Screening Battery-100 (DSB-100). Methods: The DSB-100 was administered to 46 demented individuals and 159 healthy matched controls. All demented participants met the DSM-IV criteria for dementia. The healthy controls showed no cognitive impairment and were independent in activities of daily living. The DSB-100 was administered as part of a larger neuropsychological assessment to collect additional indices on the severity of patients' dementia, depression, and frontal dysfunctions. The same information was used for comparisons with DSB-100 scores. Results: Multiple regression analysis suggested that age and education, but not the variable sex, are essential in predicting cognitive performance. Construct validation yielded 4 factors, namely attention-visuospatial factors, memory, language, and executive functions. The results showed that the DSB-100 has a high interrater reliability and an acceptable overall internal homogeneity. Conclusion: These results validate the DSB-100 and suggest its appropriateness for dementia screening in Tunisian elderly and possibly elderly people from other cultures with modifications to some subscales.
Evaluation of Various Methods of Assessing Symptoms of Cognitive Impairment and Dementia
Alzheimer Disease and Associated Disorders, 2001
Background and Purpose: The effect of different diagnostic criteria for detecting dementia in both epidemiological and stroke cohort studies has been shown, but comparison between different assessment methods has only seldom been done. We compared both assessment methods and diagnostic criteria for dementia in a large well-defined stroke cohort. Subject and Methods: A group of 227 of 486 patients aged 55 to 85 years who 3 months after ischemic stroke completed a comprehensive neuropsychological test battery, structured clinical mental status examination of defined cognitive domains with expanded Mini-Mental State Examination. The criteria for dementia were those of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III, DSM-III-R) and the National Institute of Neurological Disorders and Stroke-Associated Internationale pour la Reserche et l'Enseignement en Neurosciences (NINDS-AIREN). Results: The main differences between clinical and neuropsychological examinations were seen in memory functions: clinically 24.7% and neuropsychologically 54.2% had impairment in short-term memory and 10.4% versus 5.3% in long-term memory. Accordingly, the prevalence of dementia varied greatly: It was clinically 14.1% by DSM-III, 9.7% by DSM-III-R and 8.4% by NINDS-AIREN criteria. The corresponding frequencies based on neuropsychological evaluation were 27.3%, 4.0% and 25.6%. Between these 3 diagnostic criteria the concordance varied in clinical testing between 59.4%-68.8% (kappa 0.72-0.79) and in neuropsychological testing between 14.5%-81.1% (kappa 0.20-0.86). The concordance between clinical and neuropsychological testing was 56.8% (kappa 0.42) by DSM-III , 31.6% (kappa 0.35) by DSM-III-R and 25.5% (kappa 0.24) by NINDS-AIREN. Conclusions: The frequency of poststroke dementia and cognitive decline varied sharply when different systems of diagnostic classification and methods were used. This may have serious influences on investigation and treatment of patients. We underline the importance of further debate and studies to refine the categories of cognitive impairment used in the setting of CVD.
Age and Ageing, 2005
Background: cognitive impairment is an important part of the diagnostic criteria for dementia. The Mini-Mental State Examination (MMSE) is recommended to test for cognitive impairment and to monitor medication response. Objectives: we examined the prevalence of cognitive impairment in the UK and assessed associations with cognitive impairment. Design: cross-sectional survey as part of a cluster randomised trial. Subjects: representative sample of people aged 75 years and over. Methods: all subjects had a detailed baseline health assessment including the MMSE. Results: a total of 15,051 subjects completed the assessment (71.9%). Almost two-thirds of subjects were female (61.5%) and almost half were aged between 75 and 79 years (47.0%). The prevalence of cognitive impairment was 18.3% (95% confidence intervals (CI) = 16.0-20.9) at a cutoff of 23/24, and 3.3% (95% CI = 2.8-4.0) at 17/18. Those with impairment (MMSE 23/24) were significantly more likely to have hearing (odds ratio (OR) 1.7), vision (OR 1.7) and urinary incontinence problems (OR 1.3), have two or more falls in the previous 6 months (OR 1.4), and report poorer health (OR 1.9). Almost half the participants lived alone (n = 7,073; 47.0%) and of these almost one-fifth were impaired (MMSE 23/ 24; 19.4%).