Picture‐Based Memory Impairment Screen for Dementia

Abstract

OBJECTIVES To develop and validate a picture-based memory impairment screen (PMIS) for the detection of dementia. DESIGN Cross-sectional. SETTING Outpatient clinics, Baby Memorial Hospital, Kozhikode city in the southern Indian state of Kerala. PARTICIPANTS Three hundred four community-residing adults aged 55 to 94 with a mean education level of 8 years; 65 were diagnosed with dementia. MEASUREMENTS PMIS: a culture-fair picture-based cognitive screen designed to be administered by nonspecialists. Diagnostic accuracy estimates (sensitivity, specificity, positive and negative predictive power) of PMIS cut-scores in detecting dementia (range 0–8). RESULTS PMIS scores were worse in participants with dementia (1.5) than in controls (7.7, P < .001). At the optimal cut-score of 5, PMIS had a sensitivity of 95.4% (95% confidence interval (CI) = 90.3–100.0%) and a specificity of 99.2% (95% CI = 98.0–100.0%) for detecting dementia. In the 167 participants with <10 years of education, PMIS scores of five or less had a sensitivity of 97.8% (95% CI = 93.6–100.0%) and specificity of 99.2% (95% CI = 97.6–100.0%). The PMIS had better specificity than the Mini-Mental State Examination in detecting dementia, especially in older adults with low education. CONCLUSION The PMIS is a brief and reliable screen for dementia in elderly populations with variable literacy rates.

Screening for dementia using picture memory impairment screen among older adults in an urban underprivileged area of Bangalore city, India

“…A hospital based study by Dr Joe Varghese et al in Kerala for the validation of PMIS showed a prevalence of 21.3% among the elderly in 2010. 10 The fact that elderly persons with visual and hearing impairment were excluded could have led to a slightly higher estimate. Even so, the prevalence obtained in the study is within the range of prevalence rates reported from other studies conducted in India.…”

“…Previous community-based studies estimate the prevalence of dementia among the elderly to range from 1.5% to 14.89%. 7,9,10,[18][19][20][21]23 Considering a prevalence of 5% with 3% absolute precision at 95% confidence interval our sample size was calculated to be 202. 20 We included all older adults above 60 years who were permanent residents of the area (at least one year of residence).…”

“…6,7 Even in high income countries only 20% to 50% of elderly persons with dementia are recognized in primary care, with the situation being worse in low and middle income countries. [7][8][9][10] Effective primary care screening could potentially double the number of elderly persons who could benefit from careful planning of potential interventions. 1 Very few community based studies have been done to explore this problem in developing countries like India especially in urban underprivileged areas.…”

Depressive Symptoms and Mild Cognitive Impairment: Results from the Kerala‐Einstein Study

“…4 Participants were prospectively recruited from neurology clinics at the Baby Memorial Hospital, Kozhikode, between September 2008 and March 2012. 4 Referral reasons were cognitive complaints or other neurological symptoms including headache, stroke, or neuropathy. Cognitively normal controls were recruited from participant relatives or individuals attending the clinic for noncognitive symptoms.…”

Introductory to Issue 40(4): Growing Our Assessment Toolbox

“…I'm enthusiastic about Rosli et al's (Rosli et al, 2017) comparison of the Identification and Intervention for Dementia in Elderly Africans (IDEA) Cognitive Screen developed for dementia in a low-literacy settings (Gray et al, 2014) and the Picture-Based Memory Impairment Scale (PMIS) developed for those with little to no formal education (Verghese et al, 2012) to the Mini Mental State Examination (Folstein, Folstein, & McHugh, 1975). Their results, from Malaya, Malaysia suggest clinical equivalency without educational bias.…”