Development and Validation of a Brief Dementia Screening Indicator for Primary Care

Overview

Journal Alzheimers Dement

Specialties Neurology
Psychiatry

Date 2014 Feb 5

PMID 24491321

Citations 83

Authors

Deborah E Barnes

Alexa S Beiser

Anne Lee

Kenneth M Langa

Alain Koyama

Sarah R Preis

John Neuhaus

Ryan J McCammon

Kristine Yaffe

Sudha Seshadri

Mary N Haan

David R Weir

Affiliations

Soon will be listed here.

Abstract

Background: Detection of "any cognitive impairment" is mandated as part of the Medicare annual wellness visit, but screening all patients may result in excessive false positives.

Methods: We developed and validated a brief Dementia Screening Indicator using data from four large, ongoing cohort studies (the Cardiovascular Health Study [CHS]; the Framingham Heart Study [FHS]; the Health and Retirement Study [HRS]; the Sacramento Area Latino Study on Aging [SALSA]) to help clinicians identify a subgroup of high-risk patients to target for cognitive screening.

Results: The final Dementia Screening Indicator included age (1 point/year; ages, 65-79 years), less than 12 years of education (9 points), stroke (6 points), diabetes mellitus (3 points), body mass index less than 18.5 kg/m(2) (8 points), requiring assistance with money or medications (10 points), and depressive symptoms (6 points). Accuracy was good across the cohorts (Harrell's C statistic: CHS, 0.68; FHS, 0.77; HRS, 0.76; SALSA, 0.78).

Conclusions: The Dementia Screening Indicator is a simple tool that may be useful in primary care settings to identify high-risk patients to target for cognitive screening.

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References

Okura T, Heisler M, Langa K . Association between cognitive function and social support with glycemic control in adults with diabetes mellitus. J Am Geriatr Soc. 2009; 57(10):1816-24. PMC: 2810258. DOI: 10.1111/j.1532-5415.2009.02431.x. View

Hogan D, Bailey P, Black S, Carswell A, Chertkow H, Clarke B . Diagnosis and treatment of dementia: 4. Approach to management of mild to moderate dementia. CMAJ. 2008; 179(8):787-93. PMC: 2553866. DOI: 10.1503/cmaj.070803. View

Seshadri S, Fitzpatrick A, Ikram M, DeStefano A, Gudnason V, Boada M . Genome-wide analysis of genetic loci associated with Alzheimer disease. JAMA. 2010; 303(18):1832-40. PMC: 2989531. DOI: 10.1001/jama.2010.574. View

Barnes D, Alexopoulos G, Lopez O, Williamson J, Yaffe K . Depressive symptoms, vascular disease, and mild cognitive impairment: findings from the Cardiovascular Health Study. Arch Gen Psychiatry. 2006; 63(3):273-9. DOI: 10.1001/archpsyc.63.3.273. View

Kivipelto M, Ngandu T, Laatikainen T, Winblad B, Soininen H, Tuomilehto J . Risk score for the prediction of dementia risk in 20 years among middle aged people: a longitudinal, population-based study. Lancet Neurol. 2006; 5(9):735-41. DOI: 10.1016/S1474-4422(06)70537-3. View

Lin P, Fillit H, Cohen J, Neumann P . Potentially avoidable hospitalizations among Medicare beneficiaries with Alzheimer's disease and related disorders. Alzheimers Dement. 2013; 9(1):30-8. DOI: 10.1016/j.jalz.2012.11.002. View

Lopez O, Kuller L, Fitzpatrick A, Ives D, Becker J, Beauchamp N . Evaluation of dementia in the cardiovascular health cognition study. Neuroepidemiology. 2003; 22(1):1-12. DOI: 10.1159/000067110. View

Barberger-Gateau P, Fabrigoule C, Helmer C, Rouch I, Dartigues J . Functional impairment in instrumental activities of daily living: an early clinical sign of dementia?. J Am Geriatr Soc. 1999; 47(4):456-62. DOI: 10.1111/j.1532-5415.1999.tb07239.x. View

Stern Y . Cognitive reserve in ageing and Alzheimer's disease. Lancet Neurol. 2012; 11(11):1006-12. PMC: 3507991. DOI: 10.1016/S1474-4422(12)70191-6. View

10.

Chary E, Amieva H, Peres K, Orgogozo J, Dartigues J, Jacqmin-Gadda H . Short- versus long-term prediction of dementia among subjects with low and high educational levels. Alzheimers Dement. 2012; 9(5):562-71. DOI: 10.1016/j.jalz.2012.05.2188. View

11.

Caamano-Isorna F, Corral M, Montes-Martinez A, Takkouche B . Education and dementia: a meta-analytic study. Neuroepidemiology. 2006; 26(4):226-32. DOI: 10.1159/000093378. View

12.

Gail M, Brinton L, Byar D, Corle D, Green S, Schairer C . Projecting individualized probabilities of developing breast cancer for white females who are being examined annually. J Natl Cancer Inst. 1989; 81(24):1879-86. DOI: 10.1093/jnci/81.24.1879. View

13.

Fried L, Borhani N, Enright P, Furberg C, Gardin J, Kronmal R . The Cardiovascular Health Study: design and rationale. Ann Epidemiol. 1991; 1(3):263-76. DOI: 10.1016/1047-2797(91)90005-w. View

14.

Stephan B, Kurth T, Matthews F, Brayne C, Dufouil C . Dementia risk prediction in the population: are screening models accurate?. Nat Rev Neurol. 2010; 6(6):318-26. DOI: 10.1038/nrneurol.2010.54. View

15.

Cordell C, Borson S, Boustani M, Chodosh J, Reuben D, Verghese J . Alzheimer's Association recommendations for operationalizing the detection of cognitive impairment during the Medicare Annual Wellness Visit in a primary care setting. Alzheimers Dement. 2012; 9(2):141-50. DOI: 10.1016/j.jalz.2012.09.011. View

16.

Ganguli M, Rodriguez E, Mulsant B, Richards S, Pandav R, Vander Bilt J . Detection and management of cognitive impairment in primary care: The Steel Valley Seniors Survey. J Am Geriatr Soc. 2004; 52(10):1668-75. DOI: 10.1111/j.1532-5415.2004.52459.x. View

17.

Callahan C, Hendrie H, Tierney W . Documentation and evaluation of cognitive impairment in elderly primary care patients. Ann Intern Med. 1995; 122(6):422-9. DOI: 10.7326/0003-4819-122-6-199503150-00004. View

18.

Boise L, Neal M, Kaye J . Dementia assessment in primary care: results from a study in three managed care systems. J Gerontol A Biol Sci Med Sci. 2004; 59(6):M621-6. DOI: 10.1093/gerona/59.6.m621. View

19.

. 2013 Alzheimer's disease facts and figures. Alzheimers Dement. 2013; 9(2):208-45. DOI: 10.1016/j.jalz.2013.02.003. View

20.

Schmidt F, Oh I, Hayes T . Fixed- versus random-effects models in meta-analysis: model properties and an empirical comparison of differences in results. Br J Math Stat Psychol. 2007; 62(Pt 1):97-128. DOI: 10.1348/000711007X255327. View