Improving identification of cognitive impairment in primary care

Borson, Soo; Scanlan, James M.; Watanabe, Jill M.; Tu, Shin Ping; Lessig, Mary

doi:10.1002/gps.1470

Cited by 205 publications

(201 citation statements)

References 28 publications

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“…Physicians who did not use the Mini-Cog identified 41 percent of cognitively impaired subjects. Factors such as low education levels, low literacy levels, language barriers, nonAlzheimer type dementia, and ethnic differences did not affect the performance of the Mini-Cog (Borson et al, 2006).…”

Section: Changes In Screening Practices and Policiesmentioning

confidence: 81%

“…The Mini-Cog, a short screening tool for dementia, was created to assist primary care physicians in detecting dementia in a timely and accurate manner (Borson et al, 2006). This tool also is meant to address physicians' difficulties in identifying dementia because of sociodemographic factors and other patient-specific characteristics.…”

Section: Changes In Screening Practices and Policiesmentioning

confidence: 99%

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Racial and Ethnic Disparities Among Individuals with Alzheimer’s Disease in the United States: A Literature Review

Lines¹,

Sherif²,

Wiener³

2014

115

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This study reviews the published literature on racial and ethnic disparities among people with Alzheimer’s disease (AD) and related dementias in the United States. To identify relevant studies, we searched electronic sources for peer-reviewed journal articles and unpublished research reports that were published through July 2014; related to the AD population and their caregivers; and provided evidence of racial and ethnic disparities, discussed reasons for disparities, or described interventions to address disparities. The literature shows consistent and adverse disparities among blacks and Hispanics compared with non-Hispanic whites concerning AD, including the disease’s prevalence and incidence, mortality, participation in clinical trials, use of medications and other interventions, use of long-term services and supports, health care expenditures, quality of care, and caregiving. The literature suggests numerous underlying causes, including factors related to measurement of the disease, genetics, socioeconomic factors, cultural differences, lack of culturally competent clinicians, and discrimination. Although these disparities are well known, little is known about the effectiveness of various strategies, such as cultural competence training, to address these differences, and very few studies evaluate possible interventions.

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Section: Changes In Screening Practices and Policiesmentioning

confidence: 81%

Section: Changes In Screening Practices and Policiesmentioning

confidence: 99%

Racial and Ethnic Disparities Among Individuals with Alzheimer’s Disease in the United States: A Literature Review

Lines¹,

Sherif²,

Wiener³

2014

115

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“…disease is often under recognized in community clinical practice settings [5][6][7] because the diagnosis can be difficult 8 and may require specialized training. Without fast and reliable screening instruments, it may be difficult for primary care physicians to identify patients who should be referred for a more comprehensive dementia workup.…”

mentioning

confidence: 99%

Clock Drawing Test Ratings by Dementia Specialists: Interrater Reliability and Diagnostic Accuracy

Nair¹,

Gavett²,

Damman³

et al. 2010

Journal of Neuropsychiatry

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The authors aim to study subjective ratings of clock drawing test by clinicians and determine interrater reliability and diagnostic accuracy. The clock drawing test has been advocated over the Mini-Mental State Examination as an office screening test for dementia, but use of the clock drawing test by neurologists and dementia specialist clinicians has not been validated. The authors conducted a study of clock drawing test scoring by dementia specialists. The authors randomly assigned 25 clocks from each of six predetermined groups based on consensus diagnosis (cognitive comparison subjects, subjects with a memory complaint but with normal neuropsychological testing, subjects with probable and possible mild cognitive impairment, and subjects with possible and probable Alzheimer's disease) to dementia specialists for blinded scoring using a binary yes/no impairment system and a 0-10 scale as subjectively determined by each individual clinician rater. The authors collapsed the six groups into three (comparison subjects, mild cognitive impairment patients, and Alzheimer's disease patients) and analyzed interrater reliability, sensitivity, and specificity for consensus diagnosis of mild cognitive impairment, and Alzheimer's disease. The authors found excellent interrater reliability, sensitivity, and specificity for predicting consensus diagnosis. The 0-10 clock drawing test rating scale was more predictive of consensus diagnosis than the binary impairment scale. Based on the five clinicians' average dichotomous rating, the clinicians differentiated comparison and Alzheimer's disease participants with a sensitivity of 0.75 and a specificity of 0.81. For three of the four comparisons, a cutoff score of two or greater resulted in the maximization of sensitivity and specificity for differentiating diagnostic groups. A cutoff score of four or greater maximized sensitivity (0.54) and specificity (0.74) for differentiating Alzheimer's disease from mild cognitive impairment. Based on rating systems, clock drawing test scoring by dementia clinicians had excellent interrater reliability and sensitivity for differentiating the mild Alzheimer's disease subjects from comparison subjects. When utilizing a binary rating scale for the clock drawing test in the absence of clinical information, dementia specialist clinicians at the Boston Medical Center were moderately sensitive and highly specific in separating mild cognitive impairment from healthy comparison subjects. These dementia clinicians were also highly sensitive and less specific in differentiating mild cognitive impairment from Alzheimer's disease.Alzheimer disease is a growing public health problem 1,2 and its prevalence is increasing rapidly with the aging of the baby boomer generation. 3 Early diagnosis and treatment can reduce the burden this increase poses to the health care system and society. 4 Though diagnostically useful, quantitative clock drawing test rating schemes 18,19,20,22,23 are rarely used in clinical settings, as they take more time and require...

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“…40 However, the Mini-Cog's brevity may be an advantage when trying to improve recognition of cognitive impairment in primary care. 40,41 In addition, the Mini-Cog is not associated with the same language or education bias as the MMSE. 39,42 An example of the Mini-Cog test is provided in Appendix 1.…”

Section: Performance-based Screening Toolsmentioning

confidence: 95%

Practical Guidelines for the Recognition and Diagnosis of Dementia

Galvin

Sadowsky²

2012

The Journal of the American Board of Family Medicine

156

120

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To date, user-friendly, practical guidelines for dementia have not been available for busy family physicians. However, the growing number of patients with dementia means that primary care physicians will have an increasingly important role in the diagnosis and subsequent management of dementia. This article provides practical guidance for the recognition and diagnosis of dementia and is aimed at family physicians, who are usually the first clinicians to whom patients present with dementia symptoms. Because Alzheimer disease (AD) is the most common form of dementia, this condition is the main focus of this article. We review the pathophysiology of AD and discuss recommended diagnostic protocols and the importance of early diagnosis. An AD diagnostic algorithm is provided, with clearly defined steps for screening and diagnosing AD and assessing daily functioning, behavioral symptoms, and caregiver sta- Dementia: an OverviewAlzheimer disease (AD) is the most common form of dementia, accounting for approximately 60% of all cases, 1,2 and it is therefore the main focus of this article. AD destroys brain cells, causing problems with memory, thinking, and behavior severe enough to affect work, family, and social relationships and, eventually, the most basic activities of daily living (ADLs). AD and related disorders are a growing public health problem in the United States, with a prevalence ranging from 3% to 11% among people aged 65 years and older and from 25% to 47% among those aged older than 85 years. 3,4 There are an estimated 5.3 million cases of dementia in the United States, 5 and this number is expected to increase to 18.5 million by 2050. 6 The number of those afflicted is increasing annually as a result of the aging population. Dementia leads to a high burden of suffering for patients, families, and society, with an annual estimated cost of $172 billion. 5 People with dementia usually present first to their family physician, although an estimated 39% present to specialist clinics (neurologists, psychiatrists and geriatricians). 7 The primary care physician (PCP) is often the first physician to observe patients with possible dementia and often the only physician involved in making the diagnosis. 8 Because of the key role that PCPs play in the longterm management of elderly individuals with chronic disease, the growing number of patients with dementia will have a significant impact on these health professionals. 9 The rising number of patients with dementia means that family physicians will have an increasingly important role in recognizing early signs and symptoms of disease, ordering appropriate tests, formally diagnosing, and, finally, treating these patients. However, at present, diagnosing AD can be Funding: none. Conflict of interest:Dr Sadowsky has served as a consultant to Novartis Pharmaceuticals Corporation, has served as a speaker for Novartis Pharmaceuticals Corporation and Forest Pharmaceuticals and Accera, and has received honoraria from these companies. James E Galvin is a paid consultant for ...

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Improving identification of cognitive impairment in primary care

Cited by 205 publications

References 28 publications

Racial and Ethnic Disparities Among Individuals with Alzheimer’s Disease in the United States: A Literature Review

Racial and Ethnic Disparities Among Individuals with Alzheimer’s Disease in the United States: A Literature Review

Clock Drawing Test Ratings by Dementia Specialists: Interrater Reliability and Diagnostic Accuracy

Practical Guidelines for the Recognition and Diagnosis of Dementia

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