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Improving screening accuracy for dementia in a community sample by augmenting cognitive testing with informant report
Andrew Mackinnon1, Alireza Khalilian, Anthony F Jorm
1Department of Psychological Medicine, Monash University, and Mental Health Research Institute of Victoria, Locked Bag 11, Parkville, Victoria 3052, Australia. ajm@mhri.edu.au
Journal of Clinical Epidemiology
|May 28, 2003
Summary
Combining cognitive tests with informant reports significantly improves dementia screening accuracy in older adults. This approach enhances early detection for better community health outcomes.
Area of Science:
- Gerontology
- Neuroscience
- Psychometrics
Background:
- Early and accurate dementia screening is crucial for timely intervention and care planning in community settings.
- Existing cognitive tests may have limitations in accurately identifying all cases of dementia.
- Informant-based assessments can provide valuable complementary information regarding cognitive decline.
Purpose of the Study:
- To evaluate if combining cognitive testing with an informant report questionnaire improves dementia screening accuracy.
- To compare the diagnostic performance of individual tests versus their combined use.
- To identify optimal methods for combining these assessment tools.
Main Methods:
- A community-based sample of 646 adults aged 70-93 years was studied.
- Cognitive state was assessed using the Mini-Mental State Examination (MMSE).
- Informants completed the 16-item Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE).
- Dementia diagnosis followed DSM-III-R criteria.
- Receiver Operating Characteristic (ROC) analysis was used to assess screening performance.
Main Results:
- The combination of IQCODE and MMSE demonstrated more accurate prediction of dementia caseness than either test alone.
- A logical "or" rule and a weighted sum of scores showed superior screening performance.
- These findings replicate previous research on combining clinical assessments.
Conclusions:
- Augmenting cognitive testing with informant reports enhances dementia screening accuracy in community-dwelling older adults.
- Combining existing assessment tools offers a promising strategy for improving diagnostic performance in various screening scenarios.
- This integrated approach can lead to more effective early detection of cognitive impairment.