Does the Addenbrooke's Cognitive Examination‐revised add to the Mini‐Mental State Examination in established Alzheimer disease? Results from a national dementia research register

Law, Emma; Connelly, Peter; Randall, Emma; Mcneill, Catriona; Fox, Helen; Parra, Mario A.; Hudson, Justine; Whyte, Leigh-Ann; Johnstone, Jane; Gray, Sarah M.; Starr, John M.

doi:10.1002/gps.3828

Cited by 33 publications

(21 citation statements)

References 17 publications

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“…The coefficients of the intercept and the ACE score were statistically significant and consistent with a recent study of established dementia [28]. This latter model assumes absence of the MMSE is explained entirely by the ACE value, which may be too simplistic.…”

Section: Methodssupporting

confidence: 88%

Effectiveness of an intervention to facilitate prompt referral to memory clinics in the United Kingdom: Cluster randomised controlled trial

et al. 2017

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BackgroundMost people with dementia do not receive timely diagnosis, preventing them from making informed plans about their future and accessing services. Many countries have a policy to increase timely diagnosis, but trials aimed at changing general practitioner (GP) practice have been unsuccessful. We aimed to assess whether a GP’s personal letter, with an evidence-based leaflet about overcoming barriers to accessing help for memory problems—aimed at empowering patients and families—increases timely dementia diagnosis and patient presentation to general practice.Methods and findingMulticentre, cluster-randomised controlled trial with raters masked to an online computer-generated randomisation system assessing 1 y outcome. We recruited 22 general practices (August 2013–September 2014) and 13 corresponding secondary care memory services in London, Hertfordshire, and Essex, United Kingdom. Eligible patients were aged ≥70 y, without a known diagnosis of dementia, living in their own homes. There were 6,387 such patients in 11 intervention practices and 8,171 in the control practices. The primary outcome was cognitive severity on Mini Mental State Examination (MMSE). Main secondary outcomes were proportion of patients consulting their GP with suspected memory disorders and proportion of those referred to memory clinics. There was no between-group difference in cognitive severity at diagnosis (99 intervention, mean MMSE = 22.04, 95% confidence intervals (CIs) = 20.95 to 23.13; 124 control, mean MMSE = 22.59, 95% CI = 21.58 to 23.6; p = 0.48). GP consultations with patients with suspected memory disorders increased in intervention versus control group (odds ratio = 1.41; 95% CI = 1.28, 1.54). There was no between-group difference in the proportions of patients referred to memory clinics (166, 2.5%; 220, 2.7%; p = .077 respectively). The study was limited as we do not know whether the additional patients presenting to GPs had objective as well as subjective memory problems and therefore should have been referred. In addition, we aimed to empower patients but did not do anything to change GP practice.ConclusionsOur intervention to access timely dementia diagnosis resulted in more patients presenting to GPs with memory problems, but no diagnoses increase. We are uncertain as to the reason for this and do not know whether empowering the public and targeting GPs would have resulted in a successful intervention. Future interventions should be targeted at both patients and GPs.Trial registrationCurrent Controlled Trials ISRCTN19216873

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Section: Methodssupporting

confidence: 88%

Effectiveness of an intervention to facilitate prompt referral to memory clinics in the United Kingdom: Cluster randomised controlled trial

et al. 2017

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“…The SDCRN were able to invite all the registrants at one moment in time, in 2011, to participate in a study to see what kind of research they would value with some interesting and unexpected results [16].…”

Section: Improving Access To Research Participantsmentioning

confidence: 99%

Developing clinical research infrastructure in Scotland: the Scottish Dementia Clinical Research Network

Connelly¹,

Law²,

Starr³

2013

Clinical Investigation

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In this paper, we look at how the environment for clinical research in dementia developed in Scotland from a position where we were under-performing and had lost key academic leadership. We discuss how a clinician-led research network has improved the scope of research and is leading to a resurgence of interest in using Scotland as a base for developing and undertaking clinical research. Keywords: dementia • infrastructure • protocol development • research register Background of clinical research in Scotland prior to the set up of the Scottish Dementia

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“…The dementia sample comprised a consecutive referrals sample of 34 participants diagnosed with mild dementia (last MMSE score ≥ 24 or ACE > 70 equivalent on other cognitive screen (Law et al 2013). Diagnosis had been reached via psychiatrist-led MDT discussion in memory clinics, supported by interpretation from experienced clinical psychologists specialising in clinical neuropsychology.…”

Section: Sample Size Calculationmentioning

confidence: 99%

Impact of Dementia on Mindful Attention: a Cross-Sectional Comparison of People with Dementia and Those Without

Bousfield

Stott

2018

Mindfulness

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Mindfulness-based interventions have been suggested as ways of improving mood and cognition in people with dementia. Existing findings suggest possible benefit from a mindfulness-based group intervention. However, it is unclear whether any structured group activity (rather than mindfulness practice per se) would produce the same benefits, particularly since dementia may impact mindful attention ability. Consequently, we investigated the potential impact of having dementia on mindful attention. We compared the performance of 34 people with dementia recruited from memory services with 55 communityrecruited older people on measures of mindful attention, cognitive flexibility, and cognition, as well as putative nuisance variates of depression, anxiety and premorbid intellectual ability. The groups differed significantly on a range of demographic characteristics and some neuropsychological and mood measures. However, neither the primary prediction (that there would be a large effect size difference between groups, with people with dementia performing significantly more poorly on a measure of mindful attention to the breath), nor the secondary prediction (that performance on this measure would positively correlate with measures of executive function and overall cognition) was supported. We concluded that a diagnosis of dementia may not have a large effect on mindful attention, with consequent implications for future research.

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Does the Addenbrooke's Cognitive Examination‐revised add to the Mini‐Mental State Examination in established Alzheimer disease? Results from a national dementia research register

Cited by 33 publications

References 17 publications

Effectiveness of an intervention to facilitate prompt referral to memory clinics in the United Kingdom: Cluster randomised controlled trial

Effectiveness of an intervention to facilitate prompt referral to memory clinics in the United Kingdom: Cluster randomised controlled trial

Developing clinical research infrastructure in Scotland: the Scottish Dementia Clinical Research Network

Impact of Dementia on Mindful Attention: a Cross-Sectional Comparison of People with Dementia and Those Without

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