Quality in Ageing, 9(3), September 2008, pp.38-44.
Publisher:
Pier Professional
Place of publication:
Brighton
This paper offers a clinically informed synthesis of research and practice-based evidence on the utility, efficacy and quality of dementia screening measures. The study has three elements: a review of research literature; a small-scale survey of measures employed in three primary care trusts; and systematic clinical evaluation of the most commonly used screening instruments. Although the Mini
This paper offers a clinically informed synthesis of research and practice-based evidence on the utility, efficacy and quality of dementia screening measures. The study has three elements: a review of research literature; a small-scale survey of measures employed in three primary care trusts; and systematic clinical evaluation of the most commonly used screening instruments. Although the Mini Mental State Examination (MMSE) is widely used in the UK, this project identified the General Practitioner Assessment of Cognition (GPCOG), Memory Impairment Screen (MIS) and Mini-Cognitive Assessment Instrument (Mini-Cog) as more appropriate for routine use in primary care.
International Journal of Geriatric Psychiatry, 32(9), 2017, pp.933-939.
Publisher:
Wiley
Objectives: The clock drawing test (CDT) is a commonly used brief cognitive measure. The authors evaluated diagnostic accuracy of subjective ratings of CDT by physicians (with/without specialty in cognitive neurology) and neuropsychologists in discriminating amnestic mild cognitive impairment (aMCI), Alzheimer's dementia (AD) and cognitively healthy older adults. They further compared
(Edited publisher abstract)
Objectives: The clock drawing test (CDT) is a commonly used brief cognitive measure. The authors evaluated diagnostic accuracy of subjective ratings of CDT by physicians (with/without specialty in cognitive neurology) and neuropsychologists in discriminating amnestic mild cognitive impairment (aMCI), Alzheimer's dementia (AD) and cognitively healthy older adults. They further compared the diagnostic accuracy of subjective categorical ratings with complex scoring of CDT.
Methods: Three cognitive neurologists, three neuropsychologists and six neurology residents without experience in cognitive neurology blinded to the diagnosis rated 187 CDTs (50 mild AD, 49 aMCI and 88 cognitively healthy older adults) using a “yes” (abnormal) versus “suspected” versus “no” (normal) classification. The rating suspected was combined with yes or no to obtain two sets of sensitivity estimates. The authors also used a 17-point CDT rating system.
Results: When using the categorical rating, neuropsychologists had highest sensitivity (89%) in differentiating patients with mild AD (yes/suspected versus no), followed by neurologic residents (80%) and cognitive neurologists (79%). When differentiating patients with aMCI (yes/suspected versus no), the sensitivity was 84% for neuropsychologists, 64% for cognitive neurologists and 62% for residents. The sensitivity using the complex scoring system was 92% in patients with mild AD and 69% in patients with aMCI.
Conclusions: A categorical rating of CDT shows high sensitivity for mild AD even in non-experienced raters. Neuropsychologists outperformed physicians in differentiating patients with aMCI from cognitively healthy older adults (specificity), which was counterbalanced by the lower specificity of their ratings. The diagnostic accuracy was not substantially improved by using complex scoring system.
(Edited publisher abstract)
Advances in Mental Health and Intellectual Disabilities, 6(2), 2012, pp.99-105.
Publisher:
Emerald
Adults with Down’s syndrome are at higher risk of developing dementia than the general population and do so at an earlier age. Diagnosis of dementia in an adult with Down’s syndrome can be difficult because of the lack of a functional baseline. This paper describes a service improvement project with 2 aims: to identify and screen all adults with Down's syndrome aged over 30 years in a defined...
Adults with Down’s syndrome are at higher risk of developing dementia than the general population and do so at an earlier age. Diagnosis of dementia in an adult with Down’s syndrome can be difficult because of the lack of a functional baseline. This paper describes a service improvement project with 2 aims: to identify and screen all adults with Down's syndrome aged over 30 years in a defined locality using a standardised instrument to establish functional baselines; and to set up a database to facilitate early diagnosis of dementia in this population. An assistant psychologist used a standardised instrument to screen 65 participants with a diagnosis of Down’s syndrome who had been identified through contact with health, social, and third sector, and housing services. Three groups were identified: group 1 showed no significant change; group 2 showed significant change but no signs of dementia; and group 3 showed significant change plus signs of dementia. People with suspected dementia were referred on for further assessment and supportive services. Regular re-screening is planned for the other 2 groups. The article demonstrates how a proactive screening project can be established by employing working partnerships between intellectual disability and older adult services to aid diagnosis.
Journal of Policy and Practice in Intellectual Disabilities, 7(1), March 2010, pp.34-41.
Publisher:
Wiley
This study examined carer-reported symptoms to determine whether carer reports of decline in function would be a better screening method to detect possible cases of dementia than reports of memory decline in older adults with ID. One hundred and fifty four participants from five London boroughs were reassessed along with their carers two to three years after baseline. A questionnaire for carer...
This study examined carer-reported symptoms to determine whether carer reports of decline in function would be a better screening method to detect possible cases of dementia than reports of memory decline in older adults with ID. One hundred and fifty four participants from five London boroughs were reassessed along with their carers two to three years after baseline. A questionnaire for carer-reported change in everyday function and the Dementia Questionnaire for Persons with Mental Retardation (DMR) were used to gauge carer views of everyday function and memory. Participants who developed dementia displayed both everyday function and memory decline, where decline in function appeared to be the best indicator of new dementia cases. Retrospective carer report of change in everyday function was shown to be as good as prospective ratings to identify dementia. In those with mild ID, memory change was a better indicator of dementia, while in those with more severe ID decline in everyday function was a better indicator. The authors concluded that decline in everyday function appeared to be a better screening method for dementia than memory decline, particularly for participants with moderate to severe ID.
International Journal of Geriatric Psychiatry, 24(9), September 2009, pp.895-901.
Publisher:
Wiley
For this study the systematic review carried out for the NICE/SCIE Guidelines was updated from January 2006, Cochrane Reviews were identified, and other publications found by consultation with experts. The insidious and very variable development of dementia syndromes makes recognition of the syndrome problematic in primary care. Dementia is probably under-diagnosed and under treated...
For this study the systematic review carried out for the NICE/SCIE Guidelines was updated from January 2006, Cochrane Reviews were identified, and other publications found by consultation with experts. The insidious and very variable development of dementia syndromes makes recognition of the syndrome problematic in primary care. Dementia is probably under-diagnosed and under treated with an estimated 50% of primary care patients over 65 not diagnosed by their primary care physicians. This problem of under-diagnosis is probably not due to lack of diagnostic skills, but rather to the interaction of case-complexity, pressure on time and the negative effects of reimbursement systems. Primary care physicians often over-estimate the prevalence of dementia syndromes, but in some countries may also overestimate the prevalence of vascular dementia compared with Alzheimer's disease. Diagnosis is a step-wise process which can be aided by use of a cognitive function test, of which there are a number suitable for primary care use. Evidence based practice protocols can enhance detection rates in primary care, and there is growing evidence that communication skills in talking to people with dementia about dementia can be improved. Nevertheless there are multiple obstacles to bringing recognition forward in time, both in public awareness and professional understanding of the early changes in dementia. It is concluded that there is insufficient evidence of benefit to justify population screening in primary care but earlier recognition of people with dementia syndrome is possible within primary care. The diagnosis of dementia is a shared responsibility between generalist and specialist disciplines. Primary care physicians should explore patients' ideas and concerns around their symptoms prior to referral and tentatively discuss possible diagnoses. Once the diagnosis has been confirmed, the primary care physician should provide both practical and emotional support to allow the patient and their family to come to terms with living with dementia, and refer them for additional psychosocial support if required.
Subject terms:
primary care, screening, dementia, diagnosis, disclosure;
Journal of Integrated Care, 17(3), June 2009, pp.3-7.
Publisher:
Emerald
This article outlines the case for learning disability teams to provide routine screening of adults with Down's syndrome for early signs of dementia. It is illustrated by reference to practice in one such service where clinical and research developments have gone hand in hand, with tangible benefits to clients, carers and the multi-disciplinary team. Although specifically designed to meet...
This article outlines the case for learning disability teams to provide routine screening of adults with Down's syndrome for early signs of dementia. It is illustrated by reference to practice in one such service where clinical and research developments have gone hand in hand, with tangible benefits to clients, carers and the multi-disciplinary team. Although specifically designed to meet the challenge of the increasing number of people with Down's syndrome who develop dementia, it is applicable to the care of all people with learning disabilities.
Subject terms:
learning disabilities, screening, dementia, Downs syndrome, early intervention;
Psychiatric Bulletin, 33(2), February 2009, pp.52-54.
Publisher:
Royal College of Psychiatrists
A representative cohort of 161 patients over 65 years of age, admitted non-electively to medical and geriatric wards of a large teaching hospital were studied. Assessment for dementia was made using DSM–IV criteria. Psychiatric records were then examined, masked, to determine the involvement of psychogeriatric services. There were 111 possible cases of dementia (69%), of which 30 (27%) had prior...
A representative cohort of 161 patients over 65 years of age, admitted non-electively to medical and geriatric wards of a large teaching hospital were studied. Assessment for dementia was made using DSM–IV criteria. Psychiatric records were then examined, masked, to determine the involvement of psychogeriatric services. There were 111 possible cases of dementia (69%), of which 30 (27%) had prior local psychogeriatric case notes; in 22 cases (20%) the patient had a prior psychiatric diagnosis of dementia. Of 161 patients, 19 (12%) were seen by psychogeriatric services during their admission, of whom 12 (7%) were already known to psychiatric services. Dementia was diagnosed in 17 (complicated by delirium in 2), depression in 1 and hypomania in 1. Many patients with a possible diagnosis of dementia had no psychiatric assessment. Psychogeriatric assessment was performed on a minority of older people admitted to medical care. This population may include older people with undiagnosed dementia and unmet psychiatric care needs.
Subject terms:
hospital admission, screening, acute psychiatric care, assessment, dementia;
International Journal of Geriatric Psychiatry, 22(8), August 2007, pp.764-769.
Publisher:
Wiley
The Seven Minute Screen (7MS) is a brief cognitive case-finding instrument for dementia. The test is composed of four subtests that assess performance with regard to orientation, memory, visuospatial ability and language. The objective of this study was to describe 7MS performance in a normal sample of Norwegian people aged 65 years and older. The subjects were 66 Norwegian community-dwellers who
The Seven Minute Screen (7MS) is a brief cognitive case-finding instrument for dementia. The test is composed of four subtests that assess performance with regard to orientation, memory, visuospatial ability and language. The objective of this study was to describe 7MS performance in a normal sample of Norwegian people aged 65 years and older. The subjects were 66 Norwegian community-dwellers who met selection criteria modified from the Mayo Older American Normative Studies standard. Mean age was 73.2 years, age range was 65-93 years, and mean Mini-Mental State Examination score was 29.06, range 26-30. Analysis of the 7MS subtests revealed relatively modest influence of age, education and gender on test performance. The composite 7MS performance scores were associated with education. Normal performance was expressed as means, standard deviations and percentile values for the age groups 65-74 years and 75 + years. 7MS performance is described for a normal sample. These data have the potential to increase the clinicians' ability to interpret 7MS test results.
International Journal of Geriatric Psychiatry, 22(6), June 2007, pp.590-597.
Publisher:
Wiley
This study aimed 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. Cross-sectional comparison between two methods used...
This study aimed 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. Cross-sectional comparison between two methods used to identify dementia symptoms were used: (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 75+ 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. The two-stage screening yielded 117 patients with cognitive impairment who needed further examination; in most cases (n = 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, depressive symptoms, and cognitive functioning. 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.
Subject terms:
primary care, screening, cognitive impairment, dementia, general practitioners;
International Journal of Geriatric Psychiatry, 21(7), July 2006, pp.619-625.
Publisher:
Wiley
The aim was to examine informant validity using the Community Screening Interview for Dementia (CSI D) both cross-sectionally and longitudinally in two very different cultures and to explore the effects of informants and study participants' characteristics on the validity of informants' reports. Elderly African Americans age 65 years and older residing in Indianapolis, USA and elderly Yoruba
The aim was to examine informant validity using the Community Screening Interview for Dementia (CSI D) both cross-sectionally and longitudinally in two very different cultures and to explore the effects of informants and study participants' characteristics on the validity of informants' reports. Elderly African Americans age 65 years and older residing in Indianapolis, USA and elderly Yoruba Nigerians age 65 years and older residing in Ibadan, Nigeria were assessed on cognitive functioning using the CSI D at baseline (1992-1993) and five-year follow-up (1997-1998). At baseline, the informant validity in both samples was evaluated against participants' cognitive tests using Pearson correlation and regular regression models. At follow-up, informants ratings on cognitive decline were assessed against participants' cognitive decline scores from baseline to follow-up using biserial correlation and logistic regressions. At baseline, informants' reports on cognitive functioning significantly correlated with cognitive scores in both samples. The participant-informant relationships significantly affected the informants' reports in the two samples with different patterns at a given level of cognitive functioning. African Americans spouses reported more cognitive problems, while siblings reported more problems for the Yoruba Nigerians. At follow-up, informants' ratings on cognitive decline significantly correlated with the cognitive decline scores. The characteristics of study participants and informants had little impact on the informants' ratings on cognitive decline. Informant reports are valid in assessing the cognitive functioning of study participants both cross-sectionally and longitudinally in two very different cultures, languages and environments.
Subject terms:
screening, black and minority ethnic people, cognitive impairment, dementia, ethnicity;