Comparison of two screening instruments to detect dementia in Indian elderly subjects in a clinical setting

Abstract

Objective: Cognitive screening in elderly patients receiving treatment for chronic medical conditions in a busy outpatient clinical setting is crucial to detect dementia at an earlier stage. Although Hindi Mini-Mental State Examination (HMSE) is an established screening tool for the geriatric population in India, but cannot be administered with the informant. Our study aims to compare two screening instruments, Informant based - Eight-item Interview to Differentiate Aging and Dementia (AD8) and HMSE among elderly patients attending medical outpatient service (OPD) in a tertiary care hospital. Method: A total of 776 subjects aged ≥65 years and receiving treatment from medicine OPD in a tertiary care hospital were screened for dementia using AD8 and HMSE. The clinical diagnosis was established after detailed clinical assessment using ICD-10 criterion. Sensitivity and specificity were calculated for both screening tools and ROC curves were plotted considering ICD-10 diagnosis as the gold standard. Results: Comparison of receiver operating characteristic (ROC) curves showed that HMSE (AUC = 0.77) were better than AD8 (AUC = 0.61) in detecting dementia. Although increasing the cut-off value of AD8 from a recommended score of ≥2 to ≥3 improved sensitivity from 35% to 48.9%, high false-positive rate limited its utility as a cognitive screening tool. Conclusion: Although AD8 is easy to use and quickly administered with either patient or informant, it does not seem to be a suitable cognitive screening test for Indian elderly with chronic medical disorders. HMSE at a cut-off score of ≤23 is able to find out dementia among geriatric patients in a busy medical setting.

Diagnostic accuracy of Ascertain Dementia 8-item Questionnaire by participant and informant–A systematic review and meta-analysis

“…In the secondary care/memory clinic setting, 12 studies with 3,326 patients were included. There were seven cross-sectional studies [ 14 , 35 , 36 , 39 , 41 , 43 , 45 ], four case-control studies [ 37 , 38 , 42 , 44 ], and one prospective cohort study [ 40 ]. The mean age was 75.5 ± 9.9 years old, and 53.8% were female.…”

“…The iAD8 was used in nine studies (2,393 participants) at a cut-off of two to detect dementia [ 23 , 25 , 28 , 31 , 38 , 41 , 43 , 46 , 48 ]. The overall prevalence of dementia determined by the reference standard was 36% (95% CI: 33, 37%).…”

“…The iAD8 showed 77% sensitivity (95% CI: 69, 83, I 2 : 81.1%), 84% specificity (95% CI: 80, 87, I 2 : 77.5%), and the AUC was 0.92 ( Table 4 ). The iAD8 was used in three studies (1,094 patients) to detect dementia [ 38 , 41 , 43 ]. The overall prevalence of dementia determined by the reference standard was 23%.…”

“…In this systematic review and meta-analysis, we evaluated the predictive performance of iAD8 and pAD8 to screen for CI across all healthcare settings. The included studies were conducted in 1) community/primary care [7,10,[18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34], 2) secondary care/memory clinics [14,[35][36][37][38][39][40][41][42][43][44][45], and 3) tertiary care/hospitals [46][47][48]. We found the diagnostic accuracy of the iAD8 to be superior to the pAD8 in screening for MCI, dementia, and CI (MCI or dementia) when compared against a reference standard.…”

“…The included studies were divided into three settings: 1) community/primary care (n = 19) [7,10,[18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34], 2) secondary care/memory clinic (n = 12) [14,[35][36][37][38][39][40][41][42][43][44][45], and 3) tertiary care/hospitalized (n = 3) [46][47][48] (Tables 1 and 2). No studies were conducted in the perioperative setting such as preoperative clinics.…”