Primary care screen for early dementia

Ellen Grober, Charles Hall, Richard B. Lipton, Jeanne A. Teresi

Research output: Contribution to journalArticle

33 Scopus citations

Abstract

OBJECTIVES: To determine whether the Alzheimer's Disease Screen for Primary Care (ADS-PC) is more sensitive to early dementia than the Mini-Mental State Examination (MMSE) and whether it has as high a misclassification rate in minority patients and patients with limited education. DESIGN: Cross-sectional validation study. SETTING: Urban geriatric primary care practice. PARTICIPANTS: Three hundred sixteen African-American and Caucasian patients, including 55 patients with early dementia (Clinical Demential Rating of 0.5). MEASUREMENTS: The ADS-PC is a two-stage strategy for identifying early dementia that consists of a brief high-sensitivity dementia screen, applied to all patients aged 65 and older, and a second stage to identify memory impairment, applied to patients who fail the first stage. Differences in the sensitivities or specificities of the ADS-PC and the MMSE were evaluated using the McNemar test. RESULTS: Receiver operating characteristic curves were used to examine differences in the operating characteristics of the ADS-PC across a range of cutscores. When the specificities of both tests were equated (0.90), the sensitivities were significantly different (ADS-PC, 0.75; MMSE, 0.56). The MMSE failed to identify five times as many cases of dementia as the ADS-PC. When the sensitivities were equated, the specificities differed significantly (ADS-PC, 0.95; MMSE, 0.73). The MMSE misclassified five times as many noncases as the ADS-PC. This pattern of significantly higher sensitivity and specificity for the ADS-PC than for the MMSE was repeated in the results according to race and for individuals with high school or more education but not in individuals with less education. CONCLUSION: The ADS-PC outperformed the MMSE in identifying early dementia in a racially and educationally diverse primary care cohort.

Original languageEnglish (US)
Pages (from-to)206-213
Number of pages8
JournalJournal of the American Geriatrics Society
Volume56
Issue number2
DOIs
StatePublished - Feb 1 2008

Keywords

  • African Americans
  • Alzheimer's disease
  • Mass screening
  • Neuropsychological tests
  • Primary health care

ASJC Scopus subject areas

  • Geriatrics and Gerontology

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