Cognitive Screening in Asia: Recognizing the Role of the Patient-Family Unit

Abstract

Background/Aims: Cognitive screening programmes may improve awareness and help at-risk subjects receive earlier medical attention. Cognitive profiles of subjects who attend cognitive screening by personal choice (self-referred) compared to those where the referral was initiated by family members (family-referred) were compared. Methods: A cross-sectional survey of community subjects attending a cognitive screening initiative. Performance on the MMSE, Frontal Assessment Battery (FAB), Elderly Cognitive Assessment Questionnaire (ECAQ) and Even Briefer Assessment Scale for Depression was evaluated. Results: A total of 342 subjects with a mean age of 59.2 ± 9.0 years were screened. Overrepresentation of Chinese and Indian subjects and underrepresentation of Malay subjects was noted. The prevalence of cognitive impairment ranged from 7.0 to 9.6% depending on the screening instrument used. Of the 342 subjects, 267 were self-referred, while 75 subjects were family-referred. Family-referred subjects had lower MMSE (p < 0.001), lower ECAQ (p < 0.001) and lower FAB (p < 0.001) scores but were not more depressed compared to self-referred subjects (p = 0.904). Only the difference in ECAQ scores remained significant after adjustment for baseline differences in age and education. The prevalence of hypertension, diabetes mellitus and hypercholesterolaemia was not statistically different between the 2 groups. Conclusions: Family members play a crucial role in the diagnosis of cognitive impairment, especially in older subjects with fewer years of education.

A review of amnestic MCI screening in east/southeast Asian older adults with low education: implications for early informant-clinician collaboration

“…They might be unaware of their cognitive changes (Ausen et al , ); or might be culturally socialized to assess their own cognitive abilities differently (Wong et al , ). In such situations, these older adults would be most prone to receive medical attention for their declined cognition much later (Roe et al , ; Ng et al , ). Collateral information and qualitative analysis of informants' contributions can inform diagnostic decisions and also guide research efforts (Arlt et al , ).…”

“…Thus, there is an urgent need to increase understanding of the presentation of MCI in this population. In fact, studies in both Asia and the United States have shown that low education is not only a risk factor for dementia, but it also decreases the chance for detecting MCI or the earlier stages of dementia (Roe et al , ; Ng et al , ). As an added challenge, the need to include social and cultural factors for interpreting test scores obtained by older adults with low education further highlight the need for more research on this population (Gomez et al , ).…”

“…It is hoped that this critical review will help to increase the interest for understanding older adults with low education and provide a forum from which more pertinent research questions can be generated for future studies. The need for sensitivity and awareness of the impact of culture on older adults with low education is highlighted and thought to be useful for working with older adults from any ethnic group where families, relatives, and friends could be involved to collaboratively care for their elders (Lim et al , ; Ng et al , ).…”