A Brief Alzheimer’s screen for Use in clinical practice (original) (raw)
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Designing a Brief Alzheimer Screen (BAS)
Journal of Alzheimer's disease : JAD, 2003
With advances in the treatment of Alzheimer's disease (AD), clinical focus has shifted to early patient identification. Memory recall tests and category fluency distinguish normal individuals from early AD patients. Develop a brief test for general practitioners to screen for AD. Design. Examination of items from the MMSE and category fluency. A Brief Alzheimer Screen (BAS) was developed from cognitive assessments on 406 normal subjects and 342 mild AD patients in the CERAD (Consortium to Establish a Registry for AD) dataset. The derived measure was then applied to a second validation sample. Logistic regression was used to derive a predictive equation, which was then applied to two validation samples to estimate sensitivity and specificity. The resulting logistic model for discriminating between mild AD and controls included: recall of 3 words, number of animals named in 30 seconds, date, and spelling of WORLD backwards, (p < 0.001 for each) accounting for 77% of the varianc...
Arquivos de Neuro-Psiquiatria, 2015
The diagnosis of early signs of Alzheimer’s disease (AD) is a major challenge in a heterogeneous population. Objective To investigate the use of the Brief Cognitive Screening Battery (BCSB) for the diagnosis of mild AD in a geriatric outpatient unit of a public hospital in the city of Rio de Janeiro. Method BCSB was administered to 51 elderly adults with a clinical diagnosis of probable AD and 123 older adults without dementia (non-AD). Results AD patients performed worse than non-AD group in all BCSB tests, except Clock Drawing (p = 0.10). The ROC curves and Logistic Regression analysis indicated that delayed recall in the figure memory test was the best predictor, screening mild AD patients with sensibility and specificity superior to 80%. Conclusion The BCSB was accurate in identifying people with AD in a geriatric outpatient clinic at a public hospital, including elderly people with chronic diseases, physical frailty and cognitive impairment
Performance characteristics of a two-stage dementia screen in a population sample
Journal of Clinical Epidemiology, 2000
We analyzed the performance of a two-stage screening protocol [the Modified Mini-Mental State Exam (3MS) or the Informant Questionnaire for Cognitive Decline (IQCODE), and the Dementia Questionnaire (DQ)] in a weighted stratified sample of 839 subjects from a population survey of dementia in Cache County, UT. The subjects were subsequently examined using a standardized diagnostic assessment protocol. Using the method of receiver operating characteristic (ROC) analysis, the main outcome measure was area under the ROC curve (AUC). The overall AUC estimates were 0.956 (95% confidence interval 0.943-0.968) for the 3MS/IQCODE and 0.945 (0.931-0.960) for the DQ. After adjustment for age, the efficiency of the both 3MS/IQCODE and the DQ was better for subjects with genotype ⑀ 4/ ⑀ 4 at APOE , better among women, and better in those with two or more years duration of dementia. The optimal threshold for this two-stage screen yielded sensitivity and specificity estimates of 91.0% and 92.0%, respectively.
Validation and diagnostic accuracy of the Alzheimer's questionnaire
Age and Ageing, 2012
Background: accurately identifying individuals with cognitive impairment is difficult. Given the time constraints that many clinicians face, assessment of cognitive status is often not undertaken. The intent of this study is to determine the diagnostic accuracy of the Alzheimer's questionnaire (AQ) in identifying individuals with mild cognitive impairment (MCI) and AD. Methods: utilising a case-control design, 300 [100 AD, 100 MCI, 100 cognitively normal (CN)] older adults between the ages of 53 and 93 from a neurology practice and a brain donation programme had the AQ administered to an informant. Diagnostic accuracy was assessed through receiver-operating characteristic analysis, which yielded sensitivity, specificity and area under the curve (AUC). Results: the AQ demonstrated high sensitivity and specificity for detecting )]; [91.00 (83.60-65.80)] and AD [99.00 (94.60-100.00)]; [96.00 (90.10-98.90)]. AUC values also indicated high diagnostic accuracy for both MCI [0.95 (0.91-0.97)] and AD [0.99 (0.96-1.00)]. Internal consistency of the AQ was also high (Cronbach's alpha = 0.89).
The Alzheimer's disease assessment scale (ADAS): An instrument for early diagnosis of dementia?
International Journal of Geriatric Psychiatry, 1988
With the aim of detecting mild dementias, 94 elderly subjects who had been participating in a long‐term study since 1976 were studied by means of a new diagnostic instrument, the Alzheimer's Disease Assessment Scale (ADAS) (Rosen et al., 1984). Data available from intelligence tests performed during the course of the long‐term study were also analysed.On the basis of an independent clinical assessment, four subjects were rated as clearly demented, seven as possibly demented, and 83 as normal. A comparison of these three groups showed that the subjects classified as demented obtained significantly poorer scores on the ADAS than did the group of normal subjects. The cognitive section of the ADAS distinguished even better between the normal and the clearly demented subjects. On the other hand, there was no indication that the ADAS was specifically sensitive to degenerative types of dementia since the subject with the highest ADAS score was suffering from vascular dementia. There we...
A brief computerized self-screen for dementia
Journal of Clinical and Experimental Neuropsychology, 2009
Among his many contributions to the field of neuropsychology, Arthur Benton recognized the broad public health significance and unique ability of focused neuropsychological tests to screen for dementia. The need for validated screening tests for the presence of dementia will continue to grow as the cumulative prevalence of dementia grows and as our ability to treat or slow the progression of these diseases improves. We have developed a brief, self-administered computerized screening test for dementia, which is user friendly to the majority of elderly participants, including those with dementia. This test demonstrates comparable discriminant validity to the Mini Mental State Examination (MMSE), and its subscales correlate well with the traditional neuropsychological tests upon which it is based. We discuss its relative merits and limitations in comparison to other current instruments as well as suggesting future directions for this field.
Brief screening tests for dementia
Canadian journal of psychiatry. Revue canadienne de psychiatrie, 2002
To compare brief dementia screening tests as candidates for routine use in primary care practice. We selected screening tests that met 2 criteria: 1) administration time of 10 minutes or less in studies including individuals with, and without, dementia; and 2) performance characteristics evaluated in at least 1 community or clinical sample of older adults. We compared tests for face validity, sensitivity, and specificity in a clearly defined subject sample; for vulnerability to sociodemographic biases unrelated to dementia; for direct comparison with an accepted standard; for acceptability to patients and doctors; and for brevity and ease of administration, scoring, and interpretation by nonspecialists. Thirteen instruments met our inclusion criteria. Very short tests (1 minute or less) proved unacceptable by several criteria. Standard instruments requiring more than 5 minutes to complete, including the best-studied Mini-Mental State Examination (MMSE), were found to be too long for...
Screening for dementia with the Memory Impairment Screen
Neurology, 1999
Article abstract-Objectives: To validate a sensitive and specific screening test for AD and other dementias, assess its reliability and discriminative validity, and present normative data for its use in various applied settings. Background: To improve discrimination in screening for AD and dementia, we developed the Memory Impairment Screen (MIS), a 4-minute, four-item, delayed free-and cued-recall test of memory impairment. The MIS uses controlled learning to ensure attention, induce specific semantic processing, and optimize encoding specificity to improve detection of dementia. Methods: Equivalent forms of the MIS were given at the beginning and end of the testing session to assess alternate forms reliability. Discriminative validity was assessed in a criterion sample of 483 aged individuals, 50 of whom had dementia according to Diagnostic and Statistical Manual of Mental Disorders (3rd ed., revised) criteria. Results: The MIS had good alternate forms reliability, high construct validity for memory impairment, and good discriminative validity in terms of sensitivity, specificity, and positive predictive value. We present normative data for use in settings with different base rates (prevalences) of AD and dementia. Conclusion: The MIS provides efficient, reliable, and valid screening for AD and other dementias.
A Brief Dementia Test with Subjective and Objective Measures
Dementia and Geriatric Cognitive Disorders Extra, 2015
Background: The development of an effective brief dementia test will help in the early identification of dementia. Aim: This study investigates the diagnostic utility of a brief cognitive test for dementia which combines a short subjective informant-rated questionnaire (AD8) with an objective cognitive measure (Mini-Mental State Examination, MMSE) or its subcomponents. Methods: Subjects with mild dementia (Clinical Dementia Rating Scale score ≤ 1) were matched with community-dwelling, cognitively intact controls. MMSE and Clinical Dementia Rating Scale were administered to all subjects, while AD8 was completed by a reliable informant. Receiver operating characteristics analysis determined the diagnostic accuracies of AD8, MMSE, and AD8 combined with MMSE (AD8+MMSE). Stepwise logistic regression identified the subcomponents of MMSE which, combined with AD8, best discriminated dementia patients from controls. Results: The AD8 (area under the curve [AUC] = 0.92, 95% confidence interval [CI] 0.89-0.95) was superior to the MMSE (AUC = 0.87, 95% CI 0.83-0.92) in discriminating mild dementia patients from controls, and AD8+MMSE (AUC = 0.95, 0.92-0.98) increased its superior discrimination over MMSE alone. AD8 combined with three-item recall and intersecting pentagon copy (AUC = 0.95, 95% CI 0.92-0.97) performed as well as AD8 combined with full MMSE. Conclusion: AD8 combined with the MMSE subcomponents threeitem recall and intersecting pentagon copy has excellent diagnostic utility and is a promising brief cognitive test for early dementia.
A cognitive screening battery for dementia in the elderly
Journal of Clinical Epidemiology, 2000
The objective of this study is to propose a screening instrument for dementia based on a reduced number of neuropsychological tests. The sample consists in the pooled data of the five follow-up visits of the Paquid cohort study on cerebral aging: the estimation sample included 2792 subjects (8830 observations) and the validation sample included 985 subjects (2643 observations). Among scores significantly associated with dementia, we retained only those that increased the specificity of the model for a sensitivity of one. Seven neuropsychological tests and the MMSE subscores were considered. The most discriminant combination of tests included the MMSE and the subscores "orientation to time" and "recall three objects," the Benton Visual Retention Test, and Isaacs' Set Test of verbal fluency. The specificity of this screening instrument was 0.77 for a sensitivity of 1.