Early Dementia Questionnaire (EDQ): A new screening instrument for early dementia in primary care practice

Abstract

BackgroundWorldwide, the population is ageing, resulting in an associated increase in dementia prevalence. Forgetfulness in elderly people is often perceived as normal in some local cultures and thus, the early detection of dementia in primary care requires detection of symptoms other than memory complaints.This study was conducted to screen elderly patients for early dementia in primary care using a newly developed Early Dementia Questionnaire (EDQ) and comparing it with a standard assessment tool, the Mini Mental State Examination (MMSE).MethodsA cross-sectional study was conducted on a group of elderly patients using convenience sampling of consecutive patients. Elderly depression was excluded using the Geriatric Depression Scale (GDS). Exclusion criteria also included known cases of dementia. Inclusion criteria included a score of 5 or less in GDS and the presence of a reliable informant. A face-to-face interview was done using the EDQ with the patient and informant to elicit symptoms of early dementia. If the informant was not present, a telephone interview was used instead. The patient was then assessed with the Mini Mental State Examination (MMSE) using a cut-off point of 21.ResultsPrevalence of dementia among 155 subjects was 52.3% by EDQ and 15.5% by MMSE. The EDQ demonstrated a sensitivity of 79.2% with specificity of 52.7%. Positive predictive value (PPV) of EDQ was 23.5% with the negative predictive value (NPV) of 93.2%. The strongest predictor of possible early dementia was complaints of memory problems (OR 26.22; 95% CI 2.03–338.14) followed by complaints of concentration problems (OR 14.33; 95% CI 5.53–37.12), emotional problems (OR 4.75; 95% CI 1.64–13.81) and sleep disturbances (OR 3.14; 95% CI 1.15-8.56). Socio-demographic factors, medical problems and smoking status were not associated with possible dementia (p>0.05), despite that 60–70% of the elderly had chronic illnesses.ConclusionThe EDQ is a promising alternative to MMSE for screening of early dementia in primary care.

Diagnosing dementia in Dutch general practice: a qualitative study of GPs’ practices and views

“… 23 GPs could be supported in the diagnostic process by better validation of existing instruments, or the development of new tools that are culturally and educationally appropriate. 24 …”

Reliability and construct validity of the Early Dementia Questionnaire (EDQ)

“…Preliminary study of this new tool had shown that it is a simple, easy to administer and user friendly tool for screening of early dementia [12]. During this study, a few words were deleted from the original questionnaire (question 11 and 15) based by the response made from the pilot study of 50 respondents to make it clearer without changing the meaning of the questions.…”

“…Preliminary study on EDQ used 8 or more as the cutoff point to determine whether a patient had possible early dementia [12]. However, in this study a cutoff score of 10 is finally chosen after looking into the ROC curve and the sensitivity and specificity of different scoring.…”

“…Early Dementia Questionnaire was developed based on combination of literature review, the expert opinion of Family Medicine Consultants and Geriatric Psychiatrists and a standard assessment tool [12]. It is an interviewer guided questionnaire answered by both patient and their informant.…”

“…It is not fully dependent on patient, where the information could be obtained from the informant for scoring of the tool. It was also less influenced by educational level and patient’s social or cultural background [12]. This study was done to further validate the EDQ to assess its reliability and construct validity.…”