Development and validation of a brief dementia screening indicator for primary care

Abstract

Background Detection of “any cognitive impairment” is mandated as part of the Medicare annual wellness visit, but screening all patients may result in excessive false positives. Methods We developed and validated a brief Dementia Screening Indicator using data from four large, ongoing cohort studies (the Cardiovascular Health Study [CHS]; the Framingham Heart Study [FHS]; the Health and Retirement Study [HRS]; the Sacramento Area Latino Study on Aging [SALSA]) to help clinicians identify a subgroup of high-risk patients to target for cognitive screening. Results The final Dementia Screening Indicator included age (1 point/year; ages, 65–79 years), less than 12 years of education (9 points), stroke (6 points), diabetes mellitus (3 points), body mass index less than 18.5 kg/m2 (8 points), requiring assistance with money or medications (10 points), and depressive symptoms (6 points). Accuracy was good across the cohorts (Harrell’s C statistic: CHS, 0.68; FHS, 0.77; HRS, 0.76; SALSA, 0.78). Conclusions The Dementia Screening Indicator is a simple tool that may be useful in primary care settings to identify high-risk patients to target for cognitive screening.

Models for predicting risk of dementia: a systematic review

“…However, the model performed poorly in the validation cohort with a low AUC of 0.56. The predictive ability of a model including age, education level, stroke, diabetes mellitus, BMI, depressive symptoms, and requiring assistance with money or medications was tested in four large cohorts (the Cardiovascular Health Study (CHS), the Framingham Heart Study (FHS), the Health and Retirement Study (HRS) and the Sacramento Area Latino Study on Aging (SALSA)) 26. The accuracy for predicting 6-year incident dementia was low to moderate across the cohorts (AUC: CHS, 0.68; FHS, 0.77; HRS, 0.76; SALSA, 0.78).…”

“…The predictive performance of ANU-ADRI for AD and dementia was tested in three cohorts,13 resulting in AUCs ranging from 0.666 to 0.734. The Dementia Screening Indicator was developed using data from four cohorts26 and was then tested in each of the four cohorts separately. The AUCs ranged from 0.68 to 0.78 in the four cohorts.…”

Interarm differences in systolic blood pressure and the risk of dementia and subclinical brain injury

“…The Dementia Screening Indicator is a validated tool designed to identify patients who are 65 years or older at a high risk of dementia, who may benefit from further screening [28]. The indicator is simple to compute making it ideally suited for use in primary care.…”

“…; and (7) does the patient currently take anti-depressant medications or report that ‘everything was an effort’ at least 3 days a week over the past week? Each response is assigned a weighted score such that total scores ≥ 22 indicate a patient at high risk [28]. We classified participants as high or low risk based on this cut-off, in order to investigate whether IDSBP could predict incident dementia over and above this dementia screening indicator.…”

Routine screening in the general hospital: what happens after discharge to those identified as at risk of dementia?

“…20 In contrast, neither delirium nor transient cognitive impairment have been incorporated into primary care systems designed to flag those at risk of dementia 26 and existing risk scores for dementia are focused on vascular risk factors, which may not be as relevant in older versus younger patients. [27][28][29] There are some limitations to our study. The sample size was reduced since only a minority of primary care practices returned the questionnaires and some questionnaires were returned blank.…”