IPA survey of brief cognitive screening instruments

Background and objectives: Cognitive screening is a “first step” in detecting dementia and other neuropsychiatric syndromes and hence represents an important public health and clinical initiative. A plethora of cognitive screening instruments has been advocated in recent years, but the extent to which these instruments are used or their effectiveness is not well known. An International Psychogeriatric Association (IPA) survey was designed to determine which cognitive screening instruments were used most frequently by clinicians with special expertise in the neuropsychiatric aspects of old age and also to determine the ones considered most useful by these specialists.Method: Under the auspices of the IPA, the survey was mailed in the fall of 2004 to all IPA members as well as members of the American and Canadian Associations of Geriatric Psychiatry. The survey inquired about demographic information, the frequency of use of cognitive screening instruments, and the value attributed to the cognitive screening instruments. Participants also had an opportunity to provide written commentary.Results: A total of 334 completed surveys were processed. The majority of respondents were geriatric psychiatrists (58%). Of the 20 different instruments that were listed on the survey, only six were selected as “routinely” or “often used” by the survey respondents. These instruments in declining order were: (1) the Folstein Mini-mental State Examination; (2) the Clock Drawing Test; (3) Delayed Word Recall; (4) the Verbal Fluency Test; (5) Similarities; and (6) the Trail Making Test. “Effectiveness” and “ease of administration” were the test characteristics most highly predictive of frequency of use. Open-ended comments highlighted patient factors that continue to provide challenges, including ethnicity/culture, language, education/literacy, and sensory impairment. Respondents concluded that “no single test is adequate.”Conclusions: Psychogeriatricians worldwide routinely use a relatively small number of brief cognitive screening instruments. Further evaluation is necessary as the need increases for cognitive screening guidelines that inform public health initiatives related to dementia and neuropsychiatric syndromes.

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The Usage of Cognitive Screening Instruments: Test Characteristics and Suspected Diagnosis

Cognitive Screening Instruments ◽

10.1007/978-3-319-44775-9_15 ◽

2017 ◽

pp. 315-339 ◽

Cited By ~ 1

Author(s):

Andrew J. Larner

Keyword(s):

Screening Instruments ◽

Cognitive Screening ◽

Test Characteristics ◽

Suspected Diagnosis

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The performance of the Mini-Cog in a sample of low educational level elderly

Dementia & Neuropsychologia ◽

10.1590/s1980-57642009dn30200003 ◽

2009 ◽

Vol 3 (2) ◽

pp. 81-87 ◽

Cited By ~ 13

Author(s):

Sergio Telles Ribeiro Filho ◽

Roberto Alves Lourenço

Keyword(s):

Sensitivity And Specificity ◽

Educational Level ◽

Formal Education ◽

The Elderly ◽

University Hospital ◽

Word Recall ◽

Cognitive Screening ◽

Cross Sectional ◽

Clock Drawing Test ◽

Outpatient Unit

Abstract Objectives: To study the criterion validity of the Mini-Cog in low educational level elderly. Design: Cross-sectional and validation design. Setting: Policlínica Piquet Carneiro, an outpatient unit of Rio de Janeiro State University Hospital, in Brazil. Participants: A convenient sample consisting of 306 individuals, 65 yrs or older, selected from April 8th to July 15th, 2002. Methods: All participants underwent comprehensive geriatric evaluations which included the Mini-Mental State Examination (MMSE) and the cognitive part of the Cambridge Examination for Mental Disorders of the Elderly - Revised (CAMCOG-R). They were classified as demented or non-demented (DSM-IV). A post-hoc analysis was performed on the data from the 3 word recall test of the MMSE, and the Clock Drawing Test from the CAMCOG-R, and respective scores were added and interpreted in accordance with the Mini-Cog protocol. Results: 293 individuals completed all the study steps; 211 had 4 or less years of schooling and were included in the data analysis. 32% had dementia. Mini-Cog sensitivity and specificity was consistently low independently of the different cut-off points considered. The best performance was found at the cut-off point of 2/3 which yielded sensitivity and specificity of 60% and 65%, respectively. Conclusion: The Mini-Cog is not a good cognitive screening tool for individuals with less than five years of formal education.

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Short Clinical Assessments Applicable to Busy Practices

CNS Spectrums ◽

10.1017/s1092852900026961 ◽

2008 ◽

Vol 13 (S16) ◽

pp. 6-9 ◽

Cited By ~ 4

Author(s):

Ziad Nasreddine

Keyword(s):

Cognitive Disorders ◽

Word Recall ◽

Cognitive Screening ◽

Spatial Skills ◽

Research Committee ◽

Clock Drawing Test ◽

Clinical Assessments ◽

Visual Spatial ◽

Practice Parameters ◽

Increased Risk

Because biomarkers to detect Alzheimer’s disease (AD) have not yet been validated, physicians must rely on clinical assessments. The Research Committee of the American Neuropsychiatric Association recommended that the ideal cognitive screening instrument have the following characteristics: First, it should take <15 minutes to administer by a clinician at any level of training. Second, it should sample all major cognitive domains, including memory, attention/concentration, executive function, visual-spatial skills, language, and orientation. Third, it should be reliable, having adequate test-retest and inter-rater validity. Finally, it should be able to detect cognitive disorders commonly encountered by neuropsychiatrists.The American Academy of Neurology Practice Parameters from 1994 and 2001 and the Canadian Consensus Guidelines on Dementia from 2007 recommend that physicians screen subjects with suspected dementia or mild cognitive impairment (MCI), since these patients are at increased risk for AD. Currently, there are no data on the utility of screening subjects who are asymptomatic.The most commonly used brief cognitive tests are the Mini-Mental State Examination (MMSE), according to a survey conducted by the International Psychogeriatric Association (IPA) in 2006, followed by the clock-drawing test, the delayed-word recall, the verbal fluency test, the similarities test, and the trail-making test. Clinicians appraised these assessments as the most effective and easiest to administer (Slide 1).

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Codex (Cognitive Disorders Examination) Decision Tree Modified for the Detection of Dementia and MCI

Diagnostics ◽

10.3390/diagnostics9020058 ◽

2019 ◽

Vol 9 (2) ◽

pp. 58 ◽

Cited By ~ 5

Author(s):

Besa Ziso ◽

Andrew J. Larner

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Decision Tree ◽

Cognitive Disorders ◽

High Sensitivity ◽

Diagnostic Value ◽

Word Recall ◽

Screening Instruments ◽

Cognitive Screening ◽

Dementia Diagnosis

Many cognitive screening instruments are available to assess patients with cognitive symptoms in whom a diagnosis of dementia or mild cognitive impairment is being considered. Most are quantitative scales with specified cut-off values. In contrast, the cognitive disorders examination or Codex is a two-step decision tree which incorporates components from the Mini-Mental State Examination (MMSE) (three word recall, spatial orientation) along with a simplified clock drawing test to produce categorical outcomes defining the probability of dementia diagnosis and, by implication, directing clinician response (reassurance, monitoring, further investigation, immediate treatment). Codex has been shown to have high sensitivity and specificity for dementia diagnosis but is less sensitive for the diagnosis of mild cognitive impairment (MCI). We examined minor modifications to the Codex decision tree to try to improve its sensitivity for the diagnosis of MCI, based on data extracted from studies of two other cognitive screening instruments, the Montreal Cognitive Assessment and Free-Cog, which are more stringent than MMSE in their tests of delayed recall. Neither modification proved of diagnostic value for mild cognitive impairment. Possible explanations for this failure are considered.

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Conclusion: Place of Cognitive Screening Instruments: Test Characteristics and Suspected Diagnosis

Cognitive Screening Instruments ◽

10.1007/978-1-4471-2452-8_12 ◽

2012 ◽

pp. 219-238 ◽

Cited By ~ 3

Author(s):

Andrew J. Larner

Keyword(s):

Screening Instruments ◽

Cognitive Screening ◽

Test Characteristics ◽

Suspected Diagnosis

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Complaint-Oriented “Services”: Shelters as Tools for Criminalizing Homelessness

The Annals of the American Academy of Political and Social Science ◽

10.1177/0002716221996703 ◽

2021 ◽

Vol 693 (1) ◽

pp. 264-283

Author(s):

Chris Herring

Keyword(s):

Public Health ◽

San Francisco ◽

Homeless People ◽

Public Spaces ◽

Health Initiatives ◽

Public Health Initiatives

This article argues that the expansion of shelter and welfare provisions for the homeless can lead to increased criminalization of homeless people in public spaces. First, I document how repression of people experiencing homelessness by the police in San Francisco neighborhoods increased immediately after the opening of new shelters. Second, I reveal how shelter beds are used as a privileged tool of the police to arrest, cite, and confiscate property of the unhoused, albeit in the guise of sanitary and public health initiatives. I conclude by considering how shelters increasingly function as complaint-oriented “services,” aimed at addressing the interests of residents, businesses, and politicians, rather than the needs of those unhoused.

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Frailty, with or without Cognitive Impairment, is a Strong Predictor of Recurrent Falls in a US Population-Representative Sample of Older Adults

The Journals of Gerontology Series A ◽

10.1093/gerona/glab083 ◽

2021 ◽

Author(s):

Mei-Ling Ge ◽

Eleanor M Simonsick ◽

Bi-Rong Dong ◽

Judith D Kasper ◽

Qian-Li Xue

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Strong Predictor ◽

Word Recall ◽

Physical Frailty ◽

Frailty Phenotype ◽

Clock Drawing Test ◽

Recurrent Falls ◽

Health Aging ◽

Marginal Means

Abstract Background Physical frailty and cognitive impairment have been separately associated with falls. The purpose of the study is to examine the associations of physical frailty and cognitive impairment separately and jointly with incident recurrent falls among older adults. Methods The analysis included 6000 older adults in community or non-nursing home residential care settings who were ≥65 years and participated in the National Health Aging Trends Study (NHATS). Frailty was assessed using the physical frailty phenotype; cognitive impairment was defined by bottom quintile of clock drawing test or immediate and delayed 10-word recall, or self/proxy-report of diagnosis of dementia, or AD8 score≥ 2. The marginal means/rates models were used to analyze the associations of frailty (by the physical frailty phenotype) and cognitive impairment with recurrent falls over 6 years follow-up (2012-2017). Results Of the 6000 older adults, 1,787 (29.8%) had cognitive impairment only, 334 (5.6%) had frailty only, 615 (10.3%) had both, and 3,264 (54.4%) had neither. After adjusting for age, sex, race, education, living alone, obesity, disease burden, and mobility disability, those with frailty (with or without cognitive impairment) at baseline had higher rates of recurrent falls than those without cognitive impairment and frailty (frailty only: Rate ratio (RR)=1.31, 95% confidence interval (CI)=1.18-1.44; both: RR=1.28, 95% CI=1.17-1.40). The association was marginally significant for those with cognitive impairment only (RR=1.07, 95% CI=1.00-1.13). Conclusions Frailty and cognitive impairment were independently associated with recurrent falls in non-institutionalized older adults. There was a lack of synergistic effect between frailty and cognitive impairment.

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Advancing precision public health using human genomics: examples from the field and future research opportunities

Genome Medicine ◽

10.1186/s13073-021-00911-0 ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Megan C. Roberts ◽

Alison E. Fohner ◽

Latrice Landry ◽

Dana Lee Olstad ◽

Amelia K. Smit ◽

...

Keyword(s):

Public Health ◽

Precision Medicine ◽

Behavioral Science ◽

Public Health Research ◽

Future Research ◽

Human Genomics ◽

Precision Public Health ◽

Genomics Research ◽

Health Initiatives ◽

Public Health Initiatives

AbstractPrecision public health is a relatively new field that integrates components of precision medicine, such as human genomics research, with public health concepts to help improve population health. Despite interest in advancing precision public health initiatives using human genomics research, current and future opportunities in this emerging field remain largely undescribed. To that end, we provide examples of promising opportunities and current applications of genomics research within precision public health and outline future directions within five major domains of public health: biostatistics, environmental health, epidemiology, health policy and health services, and social and behavioral science. To further extend applications of genomics within precision public health research, three key cross-cutting challenges will need to be addressed: developing policies that implement precision public health initiatives at multiple levels, improving data integration and developing more rigorous methodologies, and incorporating initiatives that address health equity. Realizing the potential to better integrate human genomics within precision public health will require transdisciplinary efforts that leverage the strengths of both precision medicine and public health.

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