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additional information on interventions’ in ). Most were initially designed as screening tools, and thus the majority were evaluated in only one study relevant to the primary care setting (that is, 36/51 instruments see ‘supplements’, ‘supplemental content’, ‘supplement. Lin and colleagues list 51 such tools in their comprehensive review. Many patient-directed cognitive or informant-based tools are available for case-finding in the primary care setting ,. This strategy requires optimally sensitive and specific case-finding tools that are well suited to the primary care setting. Instead, speciality groups recommend a case-finding strategy whereby general practitioners (GPs) test patients with suspected or observable early signs or symptoms of cognitive impairment. National task forces and academies have concluded that routine dementia screening - that is, population-based screening of individuals irrespective of the existence of cognitive complaints - cannot be recommended based on existing data, most notably screening tests’ mediocre diagnostic specificity. The early identification of cognitive impairments is critical to initiate diagnostic procedures, since early diagnoses lead to optimal treatment and potentially improve prognoses and decrease morbidity. Thus, it provides a very efficient and valid tool to aid general practitioners in deciding whether patients with suspected cognitive impairments should be further evaluated or not (‘watchful waiting’).Ĭognitive disorders are frequently underdiagnosed and, consequently, diseases such as dementia are undertreated. ConclusionĪ new and very brief instrument for general practitioners, ‘BrainCheck’, combined three sources of information deemed critical for effective case-finding (that is, patients’ subject impairments, cognitive testing, informant information) and resulted in a nearly 90% CCR. Critically, the CCR of the combined patient- and informant-directed instruments (BrainCheck) reached nearly 90% (that is 89.4% sensitivity = 97.4%, specificity = 81.6%). Validation study: A Classification and Regression Tree analysis generated an algorithm to categorize patient-directed data which resulted in a correct classification rate (CCR) of 81.2% (sensitivity = 83.0%, specificity = 79.4%). Resultsįeasibility study: General practitioners rated the patient-directed tool as highly feasible and acceptable.

All patient and healthy control participants were administered the patient-directed tool, and informants of 113 patient and 70 healthy control participants completed the very short IQCODE. Validation study: An independent group of 288 Memory Clinic patients (mean ± SD age = 76.6 ± 7.9, education = 12.0 ± 2.6 53.8% female) with diagnoses of mild cognitive impairment (n = 80), probable Alzheimer’s disease (n = 185), or major depression (n = 23) and 126 demographically matched, cognitively healthy volunteer participants (age = 75.2 ± 8.8, education = 12.5 ± 2.7 40% female) partook. Feasibility study: 52 general practitioners rated the feasibility and acceptance of the patient-directed tool. We developed a case-finding tool comprised of patient-directed (a) questions about memory and depression and (b) clock drawing, and (c) the informant-directed 7-item version of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). The present study developed a new, very quick and easily administered case-finding tool combining these assessments (‘BrainCheck’) and tested the feasibility and validity of this instrument in two independent studies.

Optimal identification of subtle cognitive impairment in the primary care setting requires a very brief tool combining (a) patients’ subjective impairments, (b) cognitive testing, and (c) information from informants.

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