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

Deborah E Barnes; Alexa S Beiser; Anne Lee; Kenneth M Langa; Alain Koyama; Sarah R Preis; John Neuhaus; Ryan J McCammon; Kristine Yaffe; Sudha Seshadri; Mary N Haan; David R Weir

doi:10.1016/j.jalz.2013.11.006

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

Alzheimers Dement. 2014 Nov;10(6):656-665.e1. doi: 10.1016/j.jalz.2013.11.006. Epub 2014 Feb 1.

Authors

Affiliations

¹ Department of Psychiatry, University of California, San Francisco, CA, USA; Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA; Veterans Affairs Medical Center, San Francisco, CA, USA. Electronic address: Deborah.barnes@ucsf.edu.
² Department of Neurology, Boston University, Boston, MA, USA; Department of Biostatistics, Boston University, Boston, MA, USA.
³ Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA.
⁴ Institute for Social Research, University of Michigan, Ann Arbor, MI, USA; Department of Medicine, University of Michigan, Ann Arbor, MI, USA; Veterans Affairs Center for Practice Management and Outcomes Research, Ann Arbor, MI, USA.
⁵ Northern California Institute for Research and Education, San Francisco, CA, USA.
⁶ Department of Neurology, Boston University, Boston, MA, USA.
⁷ Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.
⁸ Department of Psychiatry, University of California, San Francisco, CA, USA; Department of Neurology, University of California, San Francisco, CA, USA; Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA; Veterans Affairs Medical Center, San Francisco, CA, USA.

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/m(2) (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.

Keywords: Dementia; Primary care; Risk prediction modeling; Screening.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Cohort Studies
Dementia / diagnosis*
Dementia / epidemiology
Female
Humans
Male
Mass Screening / methods*
Predictive Value of Tests
Primary Health Care*
Proportional Hazards Models
Risk Assessment

Abstract

Publication types

MeSH terms

Grants and funding