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Screening for dementia in primary care: a review of the use, efficacy and quality of measures

Published online by Cambridge University Press:  05 June 2008

A. Milne ,
A. Culverwell ,
R. Guss ,
J. Tuppen  and
R. Whelton
A. Milne*
Affiliation:
Tizard Centre, University of Kent, Canterbury, U.K.
A. Culverwell
Affiliation:
Kent and Medway NHS and Social Care Partnership Trust, St Martin's Hospital, Canterbury, U.K.
R. Guss
Affiliation:
Kent and Medway NHS and Social Care Partnership Trust, Medway Maritime Hospital, Gillingham, Kent, U.K.
J. Tuppen
Affiliation:
Kent and Medway NHS and Social Care Partnership Trust, The Beacon, Ramsgate, Kent, U.K.
R. Whelton
Affiliation:
Tizard Centre, University of Kent, Canterbury, U.K.
*
Correspondence should be addressed to: Dr Alisoun Milne, Tizard Centre, School of Social Policy, Sociology and Social Research, Beverley Farm, University of Kent, Canterbury, Kent, CT2 7LZ, U.K. Phone: +44 (0)1227-824047. Email: [email protected].
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Abstract

Background: Despite evidence that early identification of dementia is of growing policy and practice significance in the U.K., limited work has been done on evaluating screening measures for use in primary care. The aim of this paper is to offer a clinically informed synthesis of research and practice-based evidence on the utility, efficacy and quality of dementia screening measures.

Method: The study has three elements: a review of research literature, a small-scale survey of measures employed in three primary care trusts, and a systematic clinical evaluation of the most commonly used screening instruments. The study integrates data from research and clinical sources.

Results: The General Practitioner Assessment of Cognition (GPCOG), the Memory Impairment Screen (MIS), and the Mini-Cognitive Assessment Instrument (Mini-Cog) were found to be brief, easy to administer, clinically acceptable, effective, and minimally affected by education, gender, and ethnicity. All three have psychometric properties similar to the Mini-mental State Examination (MMSE).

Conclusions: Although the MMSE is widely used in the U.K., this project identifies the GPCOG, MIS and Mini-Cog as clinically and psychometrically robust and more appropriate for routine use in primary care. A coherent review of evidence coupled with an indepth evaluation of screening instruments has the potential to enhance ability and commitment to early intervention in primary care and, as part of a wider educational strategy, improve the quality and consistency of dementia screening.

Keywords

primary careGPsdementia screening measures
Type
Review Article
Information
International Psychogeriatrics , Volume 20 , Issue 5 , October 2008 , pp. 911 - 926
Copyright
Copyright © International Psychogeriatric Association 2008

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References

Alzheimer's Society (2007)). Dementia UK. London: Alzheimer's Society.Google Scholar
Ashford, W. J. et al. (2006)). Should older adults be screened for dementia? Alzheimer's and Dementia, 2, 76–85.CrossRefGoogle ScholarPubMed
Ashford, W. J. et al. (2007)). Should older adults be screened for dementia? It is important to screen for evidence of dementia! Alzheimer's and Dementia, 3, 75–80.Google Scholar
Boise, L., Camicioli, R., Morgan, D. L., Rose, J. H. and Congleton, L. (1999)). Diagnosing dementia: perspectives of primary care physicians. The Gerontologist, 39, 457–464.CrossRefGoogle ScholarPubMed
Borson, S., Scanlan, J., Brush, M., Vitaliano, P. and Dokmak, A. (2000)). The Mini-Cog: a cognitive “vital signs” measure for dementia screening in multi-lingual elderly. International Journal of Geriatric Psychiatry, 15, 1021–1027.3.0.CO;2-6>CrossRefGoogle ScholarPubMed
Borson, S., Scanlan, J. M., Watanabe, J., Tu, S. and Lessig, M. (2006)). Improving identification of cognitive impairment in primary care. International Journal of Geriatric Psychiatry, 21, 349–355.CrossRefGoogle ScholarPubMed
Boustani, M. et al. (2005)). Implementing a screening and diagnosis program for dementia in primary care. Journal of General Internal Medicine, 20, 572–577.CrossRefGoogle ScholarPubMed
Bowling, A. (2002)). Research Methods on Health: Investigating Health and Health Services. Buckingham: Open University Press.Google Scholar
Brayne, C., Nickson, J., McCracken, C., Gill, C., Johnson, A. and Study, A. G. (1998)). Cognitive function and dementia in six areas of England and Wales: the distribution of MMSE and prevalence of GMS organicity level in the MRC CFA Study. Psychological Medicine, 28, 319–335.Google Scholar
Brodaty, H. et al. (1994)). General practice and dementia: a national survey of Australian GPs. Medical Journal of Australia, 160, 10–14.Google Scholar
Brodaty, H. et al. (2002)). The GPCOG: a new screening test for dementia designed for general practice. Journal of the American Geriatrics Society, 50, 530–534.Google Scholar
Brodaty, H., Low, L., Gibson, L. and Burns, K. (2006)). What is the best dementia screening instrument for general practitioners to use? American Journal of Geriatric Psychiatry, 14, 391–400.Google Scholar
Brooke, P. and Bullock, R. (1999)). Validation of a 6-item cognitive impairment test with a view to primary care usage. International Journal of Geriatric Psychiatry, 14, 936–940.3.0.CO;2-1>CrossRefGoogle Scholar
Burns, A., Lawlor, B. and Craig, S. (2004)). Mini-Mental State Examination. Assessment Scales in Old Age Psychiatry. 2nd edn. London: Martin Dunitz.Google Scholar
Busche, H. et al. (1999)). Screening for dementia with the Memory Impairment Screen. Neurology, 52, 231–238.CrossRefGoogle Scholar
Care Services Improvement Partnership (2005)). Everybody's Business – Integrated Mental Health Services for Older Adults: A Service Development Guide. London: Department of Health.Google Scholar
Culverwell, A., Tuppen, J. and Milne, A. (2006)). Identifying Dementia in Primary Care: A Survey of Screening Measures Currently Used in East Kent. East Kent NHS and Social Care Partnership Trust.Google Scholar
Department of Health (2001)). The National Service Framework for Older People. London: Department of Health.Google Scholar
England, E. (2006)). Improving the management of dementia: simple educational initiatives for primary care teams are not enough. BMJ, 332, 681–682.Google Scholar
Erkinjuntti, T., Sulkava, R., Wikstrom, J. and Autio, L. (1987)). Short Portable Mental Status Questionnaire as a screening test for dementia and delirium among the elderly. Journal of the American Geriatrics Society, 5, 412–416.Google Scholar
Fillit, H. M. et al. (2006)). Recommendations for best practices in the treatment of Alzheimer's disease in managed care. American Journal of Geriatric Pharmacotherapy, 4 (Suppl. 1), S9–24CrossRefGoogle ScholarPubMed
Folstein, M., Folstein, S. E. and McHugh, P. (1975)). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle ScholarPubMed
Harvan, J. and Cotter, V. T. (2006)). An evaluation of dementia screening in the primary care setting. Journal of the American Academy of Nurse Practitioners, 18, 351–360.Google Scholar
Hodkinson, H. M. (1972)). Evaluation of a mental test score for assessment of mental impairment in the elderly. Age and Aging, 1, 233–238.CrossRefGoogle ScholarPubMed
Holsinger, T., Deveau, J., Boustani, M. and Williams, J. (2007)). Does this patient have dementia? JAMA, 297, 2391–2404Google Scholar
House of Commons Committee of Public Accounts (2008)). Improving Services and Support for People with Dementia. HC 228. London: The Stationery Office.Google Scholar
Iliffe, S. et al. (2002)). Dementia diagnosis and management in primary care. Dementia, 1, 11–23.Google Scholar
Iliffe, S. and Manthorpe, J. (2004)). The recognition and response to dementia in the community: lessons for professional development. Learning in Health and Social Care, 3, 5–16.Google Scholar
Jacobs, J., Bernhard, M., Delagdo, A. and Strain, J. (1997)). Cognitive capacity screening examinations. Annals of Internal Medicine, 86, 40–46.CrossRefGoogle Scholar
Kirby, M., Denihan, A., Bruce, I., Coakley, D. and Lawlor, B. (2001)). The clock drawing test in primary care: sensitivity in dementia detection and specificity against normal and depressed elderly. International Journal of Geriatric Psychiatry, 16, 935–940.Google Scholar
Kraemer, H. C. (1992)). Evaluating Medical Tests. Newbury Park, CA: Sage Publications, Inc.Google Scholar
Kuslansky, G., Buschke, H., Katz, M., Sliwinski, M. and Lipton, R. B. (2002)). Screening for Alzheimer's disease: the memory impairment screen versus the conventional three-word memory test. Journal of the American Geriatrics Society, 50, 1086–1091.CrossRefGoogle ScholarPubMed
Lehfeld, H. and Erzigkeit, H. (1997)). The SKT: a short cognitive performance test for assessing deficits in memory and attention. International Psychogeriatrics, 9 (Suppl.), 115–121.CrossRefGoogle Scholar
Lorentz, W., Scanlan, J. and Borson, S. (2002)). Brief screening tests for dementia. Canadian Journal of Psychiatry, 47, 723–733.CrossRefGoogle ScholarPubMed
Maeck, L., Haak, S., Knoblaunch, A. and Stoppe, G. (2007)). Early diagnosis of dementia in primary care: a representative eight-year follow-up study in Lower Saxony, Germany. International Journal of Geriatric Psychiatry, 22, 22–31.Google Scholar
McDowell, I. and Newell, C. (1996)). Measuring Health: A Guide to Rating Scales and Questionnaires. Oxford: Oxford University Press.Google Scholar
Mendiondo, M. S., Ashford, J. W., Kryscio, R. J. and Schmitt, F. A. (2003)). Designing a Brief Alzheimer Screen (BAS). Journal of Alzheimer's Disease, 5, 391–398.Google Scholar
Meulen, E. et al. (2004)). The seven minute screen: a neurocognitive screening test highly sensitive to various types of dementia. Journal of Neurology, Neurosurgery and Psychiatry, 75, 700–705.Google Scholar
Milne, A., Woolford, H., Mason, J. and Hatzidimitriadou, E. (2000)). The early diagnosis of dementia by GPs: an exploratory study of attitudes. Aging and Mental Health, 4, 294–302.CrossRefGoogle Scholar
Milne, A., Hamilton-West, K. and Hatzidimitriadou, E. (2005)). GP attitudes to early diagnosis of dementia: evidence of improvement? Aging and Mental Health, 9, 1–7.Google Scholar
National Audit Office (2007)). Improving Services and Support for People with Dementia. London: Stationery Office.Google Scholar
National Institute for Health and Clinical Excellence and Social Care Institute for Excellence (2006)). Dementia: Supporting People with Dementia and their Carers. Clinical Practice Guidelines. London: NICE.Google Scholar
Parker, C. and Philp, I. (2004)). Screening for cognitive impairment among older people in black and minority ethnic groups. Age and Ageing, 33, 447–452.CrossRefGoogle ScholarPubMed
Royal College of General Practitioners (1995)). Office of Population Censuses and Surveys, Department of Health and Social Security, Morbidity Statistics from General Practice: Fourth National 1991–1992. London: Her Majesty's Stationery Office.Google Scholar
Seymour, J., Saunders, P., Wattis, J. and Daly, L. (1994)). Evaluation of early dementia by a trained nurse. International Journal of Geriatric Psychiatry, 9, 37–42CrossRefGoogle Scholar
Shulman, K. I. (2000)). Clock-drawing: is it the ideal cognitive screening test? International Journal of Geriatric Psychiatry, 15, 548–561.Google Scholar
Solomon, P. R. et al. (1998)). A 7-minute neurocognitive screening battery highly sensitive toAlzheimer's disease, Archives of Neurology, 55, 349–355.Google Scholar
Sperlinger, D., Clare, L., Bradbury, N. and Culverwell, A. (2004)). Measuring Psychological Treatment Outcomes with Older People. Leicester: British Psychological Society.Google Scholar
Turner, S., Iliffe, S., Downs, M., Bryans, M., Wilcock, J. and Austin, T. (2003)). Decision support software for dementia diagnosis and management in primary care: relevance and potential. Aging and Mental Health, 7, 28–33.CrossRefGoogle ScholarPubMed
Turner, S. et al. (2004)). General practitioner's knowledge, confidence and attitudes in the diagnosis and management of dementia. Age and Ageing, 33, 461–467.CrossRefGoogle ScholarPubMed
Valcour, V., Masaki, K., Curb, J. and Blanchette, P. (2000)). The detection of dementia in the primary care setting. Archives of International Medicine, 160, 2964–2968.CrossRefGoogle ScholarPubMed
Vernooij-Dassen, M. et al. (2005)). Factors affecting timely recognition and diagnosis of dementia across Europe: from awareness to stigma. International Journal of Geriatric Psychiatry, 20, 337–386.CrossRefGoogle ScholarPubMed
Wind, A. W. et al. (1997)). Limitations of the Mini Mental State Examination in diagnosing dementia in general practice. International Journal of Geriatric Psychiatry, 12, 101–108.3.0.CO;2-R>CrossRefGoogle ScholarPubMed
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