Improving Prediction of Dementia in Primary Care

Abstract

PURPOSEThe Mini-Mental State Examination (MMSE) is one of the most widely used instruments to screen for cognitive deficits; however, this instrument alone is not sensitive enough to detect early symptoms of dementia. We aimed to investigate whether additionally using the Visual Association Test (VAT) improves the predictive value of the MMSE score for development of dementia. METHODSAnalyses were based on data from 2,690 primary care patients aged 70 to 78 years who participated in the Prevention of Dementia by Intensive Vascular Care (preDIVA) trial. We assessed change in the 30-point MMSE score over 2 years and the VAT score at 2 years-dichotomized as perfect (6 points) or imperfect (≤5 points)-and evaluated the predictive values of these tests for a diagnosis of dementia in the subsequent 4 to 6 years. Data were analyzed with logistic regression analysis. RESULTSPatients having a decline of 2 points or more in total MMSE score over 2 years had an odds ratio of 3.55 (95% CI, 2.51-5.00) for developing dementia. Patients having the same decline in MMSE score plus an imperfect VAT score had an odds ratio of 9.55 (95% CI, 5.89-15.41) for developing dementia. A 1-point decline in MMSE score increased odds of dementia only when the VAT score was imperfect. Dementia risk for patients with a 2-or 3-point decrease in MMSE score and a perfect VAT score did not differ significantly from the average risk of the cohort as a whole.CONCLUSIONS Administering the VAT in patients with a small decline on the MMSE over a 2-year period has substantial incremental value for identifying those at elevated risk for developing dementia. This simple test may help distinguish older adults who need further cognitive examination from those in whom a watchful waiting policy is justified. 2018;16:206-210. https://doi Ann Fam Med

Sex Differences in the Relation Between Subjective Memory Complaints, Impairments in Instrumental Activities of Daily Living, and Risk of Dementia

“…We found that sex-differences in predictive power of IADL-I may be due to the different distribution of IADL scores in men and women. The median IADL score was somewhat higher in men, and when using Fourth, we adjusted for cognitive functioning using the MMSE, a relatively crude cognitive measure, and the VAT, which has high specificity but low sensitivity for predicting dementia [45]. These could have missed very subtle cognitive deficits.…”

The Effects of Social Activities and Living Arrangements on Cognitive Functions in Middle-aged and Elderly Adults: A Panel Study Using the 2006-2018 Korean Longitudinal Study of Aging

“…Thus, a variable that could represent the change in cognitive functions over time was more desirable. Jongstra et al [ 20 ] reported that the odds ratio of developing dementia was 3.55 (95% confidence interval [CI], 2.51 to 5.00) for elderly populations in primary care who showed a ≥2 point decline in the MMSE score over 2 years. However, according to the study by Hensel et al [ 21 ], changes in the range of 2-4 points over 1.5 years were necessary to conclude that an individual experienced a true change (90% confidence) in MMSE results.…”

Benefits of VR Physical Exercise on Cognition in Older Adults with and without Mild Cognitive Decline: A Systematic Review of Randomized Controlled Trials

“…Cognitive function declines with age [ 1 ]. This decline is an indicator of lower well-being [ 2 ] and a risk of dementia in the future [ 3 , 4 ]. Considering the growth of the older adult population, it is important to delay or prevent dementia in healthy older adults and older adults with mild cognitive decline [ 5 ].…”