Clinical Utility of Cognistat in Multiprofessional Team Evaluations of Patients with Cognitive Impairment in Swedish Primary Care

Abstract

Background. Diagnostic evaluations of dementia are often performed in primary health care (PHC). Cognitive evaluation requires validated instruments. Objective. To investigate the diagnostic accuracy and clinical utility of Cognistat in a primary care population. Methods. Participants were recruited from 4 PHC centres; 52 had cognitive symptoms and 29 were presumed cognitively healthy. Participants were tested using the Mini-Mental State Examination (MMSE), the Clock Drawing Test (CDT), and Cognistat. Clinical diagnoses, based on independent neuropsychological examination and a medical consensus discussion in secondary care, were used as criteria for diagnostic accuracy analyses. Results. The sensitivity, specificity, positive predictive value, and negative predictive value were 0.85, 0.79, 0.85, and 0.79, respectively, for Cognistat; 0.59, 0.91, 0.90, and 0.61 for MMSE; 0.26, 0.88, 0.75, and 0.46 for CDT; 0.70, 0.79, 0.82, and 0.65 for MMSE and CDT combined. The area under the receiver operating characteristic curve was 0.82 for Cognistat, 0.75 for MMSE, 0.57 for CDT, and 0.74 for MMSE and CDT combined. Conclusions. The diagnostic accuracy and clinical utility of Cognistat was better than the other tests alone or combined. Cognistat is well adapted for cognitive evaluations in PHC and can help the general practitioner to decide which patients should be referred to secondary care.

Decreased Gray Matter Volume of Right Inferior Parietal Lobule Is Associated With Severity of Mental Disorientation in Patients With Mild Cognitive Impairment

“…MMSE is a frequently used assessment tool for cognitive function (7) that can identify disorientation in early AD and in those at high-risk of cognitive decline (17). COGNISTAT has recently been introduced to evaluate cognitive function because its diagnostic accuracy and clinical utility were better than those for MMSE in a primary care population (18). COGNISTAT includes an orientation subtest for people, besides those for time and space.…”

Differences in diagnostic process, treatment and social Support for Alzheimer's dementia between primary and specialist care: resultss from the Swedish Dementia Registry

“…There are large differences between healthcare systems in the independence and experience of PC physicians and how much they are relied upon for dementia diagnosis [ 3 , 18 ]. A lack of confidence and fear of ‘rushing to diagnosis’ were cited as concerns from PC physicians in a UK study, although diagnosis in PC had been initiated as a pilot trial ongoing for only a year [ 1 ].…”

“…There is ongoing effort to improve diagnosis in PC. The MMSE and clock tests have proven reliable in this setting, especially when combined, but other instruments have also been proposed [ 18 , 23 ]. PC centres perform well in other variables: costs of diagnosing dementia are lower in PC [ 24 ], and follow-up of drug treatment prescribed by SCs is good [ 25 ].…”

The Cognistat (neurobehavioural cognitive status exam): Administering the full test in stroke patients for optimal results

“…In order to maintain the Cognistats functionality and intended screening purpose, it is recommended that the entire test be administered to screen for cognitive impairment in stroke patients, regardless of whether the screen item is passed. However, having patients complete all screen and metric items lengthens the administration time from between 10 and 20 minutes (Brown et al ., ) to closer to 30 minutes (Nøkleby et al ., ), the extra time it takes to perform the Cognistat has to be considered as a limited cost if the test allows rehabilitation staff to provide an early, accurate diagnosis and treatment, there is a benefit of lower social cost (Johansson, Kvitting, Wressle & Marcusson, ).…”