scholarly journals Cognitive screening test in primary care

2018 ◽  
Vol 52 ◽  
pp. 88 ◽  
Author(s):  
Juliana Emy Yokomizo ◽  
Katrin Seeher ◽  
Glaucia Martins de Oliveira ◽  
Laís dos Santos Vinholi e Silva Silva ◽  
Laura Saran ◽  
...  
Keyword(s):  
Primary Care ◽  
Diagnostic Accuracy ◽  
Educational Level ◽  
High Sensitivity ◽  
Cognitive Screening ◽  
Operating Characteristics ◽  
Predictive Values ◽  
Brazilian Version ◽  
Logistic Regressions ◽  
State Examination

OBJECTIVE: To establish the diagnostic accuracy of the Brazilian version of the General Practitioner Assessment of Cognition (GPCOG-Br) compared to the Mini-Mental State Examination (MMSE) in individuals with low educational level. METHODS: Ninety-three patients (≥ 60 years old) from Brazilian primary care units provided sociodemographic, cognitive, and functional data. Receiver operating characteristics, areas under the curve (AUC) and logistic regressions were conducted. RESULTS: Sixty-eight patients with 0–4 years of education. Cases (n = 44) were older (p = 0.006) and performed worse than controls (n = 49) on all cognitive or functional measures (p < 0.001). The GPCOG-Br demonstrated similar diagnostic accuracy to the MMSE (AUC = 0.90 and 0.91, respectively) and similar positive and negative predictive values (PPV/NPV, respectively: 0.79/0.86 for GPCOG-Br and 0.79/0.81 for MMSE). Adjusted cut-points displayed high sensitivity (all 86%) and satisfactory specificity (65%–80%). Lower educational level predicted lower cognitive performance. CONCLUSIONS: The GPCOG-Br is clinically well-suited for use in primary care.

MACE versus MoCA: equivalence or superiority? Pragmatic diagnostic test accuracy study

2017 ◽  
Vol 29 (6) ◽  
pp. 931-937 ◽  
Author(s):  
A.J. Larner
Keyword(s):  
Secondary Care ◽  
Characteristic Curve ◽  
High Sensitivity ◽  
Screening Instrument ◽  
Test Accuracy ◽  
Cognitive Screening ◽  
Net Benefit ◽  
Dementia Diagnosis ◽  
Predictive Values ◽  
Accuracy Study

ABSTRACTBackground:The Mini-Addenbrooke's Cognitive Examination (MACE) is a new brief cognitive screening instrument for dementia and mild cognitive impairment (MCI). Historical data suggest that MACE may be comparable to the Montreal Cognitive Assessment (MoCA), a well-established cognitive screening instrument, in secondary care settings, but no head-to-head study has been reported hitherto.Methods:A pragmatic diagnostic accuracy study of MACE and MoCA was undertaken in consecutive patients referred over the course of one year to a neurology-led Cognitive Function Clinic, comparing their performance for the diagnosis of dementia and MCI using various test metrics.Results:In a cohort of 260 patients with dementia and MCI prevalence of 17% and 29%, respectively, both MACE and MoCA were quick and easy to use and acceptable to patients. Both tests had high sensitivity (>0.9) and large effect sizes (Cohen's d) for diagnosis of both dementia and MCI but low specificity and positive predictive values. Area under the receiver operating characteristic curve was excellent for dementia diagnosis (both >0.9) but less good for MCI (MoCA good and MACE fair). In contrast, weighted comparison suggested test equivalence for dementia diagnosis but with a slight net benefit for MACE for MCI diagnosis.Conclusions:MACE is an acceptable and accurate test for the assessment of cognitive problems, with performance comparable to MoCA. MACE appears to be a viable alternative to MoCA for testing patients with cognitive complaints in a secondary care setting.

scholarly journals Diagnostic accuracy of B scan ultrasonography for posterior segment eye disorders in a tertiary care setting in Eastern India

2020 ◽  
Author(s):  
Maheswar Chaudhury ◽  
Bikash Parida ◽  
Sandeep Kumar Panigrahi
Keyword(s):  
Diagnostic Accuracy ◽  
Care Center ◽  
Tertiary Care ◽  
High Sensitivity ◽  
Posterior Segment ◽  
Radiology Department ◽  
Posterior Chamber ◽  
Eastern India ◽  
Predictive Values ◽  
Eye Disorders

Introduction: Ophthalmic ultrasound (USG) produces real time high resolution images of the eye and orbit. It can categorize and predict the location of pathology in the posterior chamber of eye very well. It is useful even in pre-operative evaluation and diagnosing posterior segment eye disorders. However, the diagnostic accuracy has usually not being studied thoroughly, with special emphasis to its probability of predicting posterior-segment eye disorders using B-scan USG. Objectives: To find out the prevalence and pattern of posterior segment disorders using B-scan ultrasonography, and to find its diagnostic accuracy. Materials and Methods: The study was prospective in nature and conducted in the department of radiodiagnosis and ophthalmology of a tertiary care center of Eastern India. Patients referred to the radiology department for ruling out intra-ocular pathology using B-scan ophthalmic ultrasound were included in the study, irrespective of any age and gender. Data were captured on an excel sheet and analyzed using Stata 12.1 SE. Results: The mean age of 84 study participants was 37.4 ± 19.5 years, with maximum in between 40-50 years. Males were more (72.6%). 50% presented with low vision, and most commonly associated with cataract (45%). Prevalance of posterior segment eye disorders was 13.1%. Sensitivity and negative predictive values were 100%. Post-test probability was 95.5%. Accuracy was however very less (39.3%). Conclusion: Using B-scan ultrasonography for pre-operative assessment and confirmation of diagnosis increases the probability of detecting presence or absence of posterior segment pathology. Absence of posterior segment disorder using this is also very helpful in ruling out disease entirely. It also a very high sensitivity and hence can be used even in rural health centers.

scholarly journals Cognitive screening instruments for dementia: comparing metrics of test limitation

2021 ◽  
Vol 15 (4) ◽  
pp. 458-463
Author(s):  
Andrew J. Larner
Keyword(s):  
Cognitive Impairment ◽  
High Sensitivity ◽  
Misclassification Rate ◽  
Test Accuracy ◽  
Screening Instruments ◽  
Cognitive Screening ◽  
Net Benefit ◽  
Likelihood Ratios ◽  
Sensitivity Specificity ◽  
State Examination

ABSTRACT Cognitive screening instruments (CSIs) for dementia and mild cognitive impairment are usually characterized in terms of measures of discrimination such as sensitivity, specificity, and likelihood ratios, but these CSIs also have limitations. Objective: The aim of this study was to calculate various measures of test limitation for commonly used CSIs, namely, misclassification rate (MR), net harm/net benefit ratio (H/B), and the likelihood to be diagnosed or misdiagnosed (LDM). Methods: Data from several previously reported pragmatic test accuracy studies of CSIs (Mini-Mental State Examination, the Montreal Cognitive Assessment, Mini-Addenbrooke’s Cognitive Examination, Six-item Cognitive Impairment Test, informant Ascertain Dementia 8, Test Your Memory test, and Free-Cog) undertaken in a single clinic were reanalyzed to calculate and compare MR, H/B, and the LDM for each test. Results: Some CSIs with very high sensitivity but low specificity for dementia fared poorly on measures of limitation, with high MRs, low H/B, and low LDM; some had likelihoods favoring misdiagnosis over diagnosis. Tests with a better balance of sensitivity and specificity fared better on measures of limitation. Conclusions: When deciding which CSI to administer, measures of test limitation as well as measures of test discrimination should be considered. Identification of CSIs with high MR, low H/B, and low LDM, may have implications for their use in clinical practice.

MACE for the Diagnosis of Dementia and MCI: 3-Year Pragmatic Diagnostic Test Accuracy Study

2018 ◽  
Vol 45 (5-6) ◽  
pp. 300-307 ◽  
Author(s):  
John C. Williamson ◽  
Andrew J. Larner
Keyword(s):  
Diagnostic Test ◽  
Cognitive Disorders ◽  
High Sensitivity ◽  
Diagnostic Test Accuracy ◽  
Test Accuracy ◽  
Cognitive Screening ◽  
Predictive Values ◽  
Diagnosis Of Dementia ◽  
Accuracy Study ◽  
Secondary Care Setting

Background/Aims: The Mini-Addenbrooke’s Cognitive Examination (MACE) is a relatively new short cognitive screening instrument for the detection of patients with dementia and mild cognitive impairment (MCI). Few studies of the MACE have been reported hitherto. The aim of this study was to undertake a pragmatic diagnostic test accuracy study of MACE in a large cohort of patients seen in a dedicated cognitive disorders clinic. Methods: MACE was administered to consecutive patients referred to a neurology-led Cognitive Function Clinic over the course of 3 years to assess its performance for the diagnosis of dementia and MCI using various test metrics. Results: In a cohort of 599 patients, the prevalence of dementia and MCI by criterion diagnosis was 0.17 and 0.29, respectively. MACE had a high sensitivity (> 0.9) and negative predictive values (> 0.8) with large effect sizes (Cohen’s d > 1) for the diagnosis of both dementia and MCI but a low specificity (< 0.5) and positive predictive values (≤0.5). Conclusion: MACE is an acceptable test for the assessment of cognitive complaints in a secondary care setting with good metrics for identifying cases of both dementia and MCI.

Optimising the Cutoffs of Cognitive Screening Instruments in Pragmatic Diagnostic Accuracy Studies: Maximising Accuracy or the Youden Index?

2015 ◽  
Vol 39 (3-4) ◽  
pp. 167-175 ◽  
Author(s):  
Andrew J. Larner
Keyword(s):  
Diagnostic Accuracy ◽  
Alternative Methods ◽  
Youden Index ◽  
Test Accuracy ◽  
Screening Instruments ◽  
Cognitive Screening ◽  
Optimal Method ◽  
Index Method ◽  
State Examination ◽  
Addenbrooke’S Cognitive Examination

Background/Aims: The optimal method of establishing test cutoffs or cutpoints for cognitive screening instruments (CSIs) is uncertain. Of the available methods, two base cutoffs on either the maximal test accuracy or the maximal Youden index. The aim of this study was to compare the effects of using these alternative methods of establishing cutoffs. Methods: Datasets from three pragmatic diagnostic accuracy studies which examined the Mini-Mental State Examination (MMSE), the Addenbrooke's Cognitive Examination-Revised (ACE-R), the Montreal Cognitive Assessment (MoCA), and the Test Your Memory (TYM) test were analysed to calculate test sensitivity and specificity using cutoffs based on either maximal test accuracy or the maximal Youden index. Results: For ACE-R, MoCA, and TYM, optimal cutoffs for dementia diagnosis differed from those in index studies when defined using either the maximal accuracy or the maximal Youden index method. Optimal cutoffs were higher for MMSE, MoCA, and TYM when using the maximal Youden index method and consequently more sensitive. Conclusion: Revision of the cutoffs for CSIs established in index studies may be required to optimise performance in pragmatic diagnostic test accuracy studies which more closely resemble clinical practice.

scholarly journals Frontal assessment battery in a Brazilian sample of healthy controls: normative data

2012 ◽  
Vol 70 (4) ◽  
pp. 278-280 ◽  
Author(s):  
Rogério Beato ◽  
Viviane Amaral-Carvalho ◽  
Henrique Cerqueira Guimarães ◽  
Vitor Tumas ◽  
Carolina Pinto Souza ◽  
...  
Keyword(s):  
Educational Level ◽  
Healthy Subjects ◽  
Mini Mental State Examination ◽  
Frontal Assessment Battery ◽  
Age And Gender ◽  
Assessment Battery ◽  
Brazilian Sample ◽  
Brazilian Version ◽  
And Gender ◽  
State Examination

OBJECTIVE: To show data on the performance of healthy subjects in the Frontal Assessment Battery (FAB), correlating with gender, age, education, and scores in the Mini-Mental State Examination (MMSE). METHODS: Two hundred and seventy-five healthy individuals with mean age of 66.4±10.6 years-old were evaluated. Mean total FAB scores were established according to the educational level. RESULTS: Mean total FAB scores according to the educational level were 10.9±2.3, for one to three years; 12.8±2.7, for four to seven years; 13.8±2.2, for eight to 11 years; and 15.3±2.3, for 12 or more years. Total FAB scores correlated significantly with education (r=0.47; p<0.0001) and MMSE scores (r=0.39; p<0.0001). No correlation emerged between FAB scores, age, and gender. CONCLUSION: In this group of healthy subjects, the Brazilian version of the FAB proved to be influenced by the education level, but not by age and gender.

scholarly journals Brazilian version of the Frontal Assessment Battery (FAB): Preliminary data on administration to healthy elderly

2007 ◽  
Vol 1 (1) ◽  
pp. 59-65 ◽  
Author(s):  
Rogério Gomes Beato ◽  
Ricardo Nitrini ◽  
Ana Paula Formigoni ◽  
Paulo Caramelli
Keyword(s):  
Preliminary Data ◽  
Educational Level ◽  
Depression Scale ◽  
Frontal Assessment Battery ◽  
Assessment Battery ◽  
Healthy Elderly ◽  
Brazilian Version ◽  
The Mean ◽  
Frontal Lobe Syndrome ◽  
State Examination

Abstract The Frontal Assessment Battery (FAB) has been proposed as a diagnostic tool for patients with frontal lobe syndrome. Objectives: To present the Brazilian version of the FAB and to show preliminary data on the performance of healthy elderly in the battery, correlating with age, education and scores in the MiniMental State Examination (MMSE). Methods: Forty-eight healthy elderly individuals (34 female/14 male) were evaluated, aged 69.3±6.1 years and with educational level=8.0±5.6 years. The subjects were submitted to the MMSE, the Cornell depression scale and the FAB, in which scores were determined for each item and for the total scale. All individuals had to attain above education adjusted cut-off scores in the MMSE and ≤7 points on the Cornell depression scale. Correlations were calculated between FAB total scores and age, educational level and MMSE scores, as well as between FAB items and education. Results: The mean score ±SD in the FAB was 13.0±2.3 (7 to 18). Total FAB scores correlated significantly with education (r=0.37; p=0.01) and MMSE scores (r=0.46; p=0.001). No correlation emerged between FAB scores and age. The mean score ±SD of the MMSE was 27.4 ± 1.8. Considering the six FAB items separately, two of them (similarities and conflicting instructions) correlated significantly with educational. Conclusions: In this group of healthy elderly, the Brazilian version of the FAB proved to be influenced by education, but not age.

A meta-analysis of the accuracy of the Addenbrooke's Cognitive Examination (ACE) and the Addenbrooke's Cognitive Examination-Revised (ACE-R) in the detection of dementia

2013 ◽  
Vol 26 (4) ◽  
pp. 555-563 ◽  
Author(s):  
Andrew J. Larner ◽  
Alex J. Mitchell
Keyword(s):  
Primary Care ◽  
Diagnostic Accuracy ◽  
Mini Mental State Examination ◽  
Meta Analysis ◽  
Screening Tools ◽  
High Prevalence ◽  
Memory Clinics ◽  
State Examination ◽  
Addenbrooke’S Cognitive Examination ◽  
Prevalence Of Dementia

ABSTRACTBackground:The Addenbrooke's Cognitive Examination (ACE) and its Revised version (ACE-R) are relatively new screening tools for cognitive impairment that may improve upon the well-known Mini-Mental State Examination (MMSE) and other brief batteries. We systematically reviewed diagnostic accuracy studies of ACE and ACE-R.Methods:Published studies comparing ACE, ACE-R and MMSE were comprehensively sought and critically appraised. A meta-analysis of suitable studies was conducted.Results:Of 61 possible publications identified, meta-analysis of qualifying studies encompassed 5 for ACE (1,090 participants) and 5 for ACE-R (1156 participants); of these, 9 made direct comparisons with the MMSE. Sensitivity and specificity of the ACE were 96.9% (95% CI = 92.7% to 99.4%) and 77.4% (95% CI = 58.3% to 91.8%); and for the ACE-R were 95.7% (95% CI = 92.2% to 98.2%) and 87.5% (95% CI = 63.8% to 99.4%). In a modest prevalence setting, such as primary care or general hospital settings where the prevalence of dementia may be approximately 25%, overall accuracy of the ACE (0.823) was inferior to ACE-R (0.895) and MMSE (0.882). In high prevalence settings such as memory clinics where the prevalence of dementia may be 50% or higher, overall accuracy again favored ACE-R (0.916) over ACE (0.872) and MMSE (0.895).Conclusions:The ACE-R has somewhat superior diagnostic accuracy to the MMSE while the ACE appears to have inferior accuracy. The ACE-R is recommended in both modest and high prevalence settings. Accuracy of newer versions of the ACE remain to be determined.

scholarly journals Diagnostic Accuracy and User-Friendliness of 5 Point-of-Care D-Dimer Tests for the Exclusion of Deep Vein Thrombosis

2010 ◽  
Vol 56 (11) ◽  
pp. 1758-1766 ◽  
Author(s):  
Geert-Jan Geersing ◽  
Diane B Toll ◽  
Kristel JM Janssen ◽  
Ruud Oudega ◽  
Marloes JC Blikman ◽  
...  
Keyword(s):  
Primary Care ◽  
Diagnostic Accuracy ◽  
Point Of Care ◽  
Reference Method ◽  
Roc Curves ◽  
Color Contrast ◽  
User Friendliness ◽  
Predictive Values ◽  
Point Of Care Tests ◽  
D Dimer

BACKGROUND Point-of-care D-dimer tests have recently been introduced to enable rapid exclusion of deep venous thrombosis (DVT) without the need to refer a patient for conventional laboratory-based D-dimer testing. Before implementation in practice, however, the diagnostic accuracy of each test should be validated. METHODS We analyzed data of 577 prospectively identified consecutive primary care patients suspected to have DVT, who underwent 5 point-of-care D-dimer tests—4 quantitative (Vidas®, Pathfast™, Cardiac®, and Triage®) and 1 qualitative (Clearview Simplify®)—and ultrasonography as the reference method. We evaluated the tests for the accuracy of their measurements and submitted a questionnaire to 20 users to assess the user-friendliness of each test. RESULTS All D-dimer tests showed negative predictive values higher than 98%. Sensitivity was high for all point-of-care tests, with a range of 0.91 (Clearview Simplify) to 0.99 (Vidas). Specificity varied between 0.39 (Pathfast) and 0.64 (Clearview Simplify). The quantitative point-of-care tests showed similar and high discriminative power for DVT, according to calculated areas under the ROC curves (range 0.88–0.89). The quantitative Vidas and Pathfast devices showed limited user-friendliness for primary care, owing to a laborious calibration process and long analyzer warm-up time compared to the Cardiac and Triage. For the qualitative Clearview Simplify assay, no analyzer or calibration was needed, but interpretation of a test result was sometimes difficult because of poor color contrast. CONCLUSIONS Point-of-care D-dimer assays show good and similar diagnostic accuracy. The quantitative Cardiac and Triage and the qualitative Clearview Simplify D-dimer seem most user-friendly for excluding DVT in the doctor's office.

scholarly journals Diagnostic Accuracy of Body Mass Index in Defining Childhood Obesity: Analysis of Cross-Sectional Data from Ghanaian Children

2019 ◽  
Vol 17 (1) ◽  
pp. 36
Author(s):  
Theodosia Adom ◽  
André Pascal Kengne ◽  
Anniza De Villiers ◽  
Rose Boatin ◽  
Thandi Puoane
Keyword(s):  
Body Mass Index ◽  
Childhood Obesity ◽  
Diagnostic Accuracy ◽  
Body Mass ◽  
Body Fat ◽  
World Health ◽  
Percent Body Fat ◽  
Screening Methods ◽  
Operating Characteristics ◽  
Predictive Values

Background: Screening methods for childhood obesity are based largely on the published body mass index (BMI) criteria. Nonetheless, their accuracy in African children is largely unknown. The diagnostic accuracies of the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC), and the International Obesity Taskforce (IOTF) BMI-based criteria in defining obesity using deuterium dilution as a criterion method in a sample of Ghanaian children are presented. Methods: Data on anthropometric indices and percent body fat were collected from 183 children aged 8–11 years. The sensitivity, specificity, and predictive values were calculated. The overall performance of the BMI criteria was evaluated using the receiver operating characteristics area under the curve (AUC). Results: Overall sensitivity of WHO, CDC, and IOTF were 59.4% (40.6–76.3), 53.1% (34.7–70.9), and 46.9% (29.1–65.3) respectively. The overall specificity was high, ranging from 98.7% by WHO to 100.0% by IOTF. The AUC were 0.936 (0.865–1.000), 0.924 (0.852–0.995), and 0.945 (0.879–1.000) by the WHO, CDC, and IOTF criteria respectively for the overall sample. Prevalence of obesity by the WHO, CDC, IOTF, and deuterium oxide-derived percent body fat were 11.5%, 10.4%, 8.2%, and 17.5% respectively, with significant positive correlations between the BMI z-scores and percent body fat. Conclusions: The BMI-based criteria were largely specific but with moderate sensitivity in detecting excess body fat in Ghanaian children. To improve diagnostic accuracy, direct measurement of body fat and other health risk factors should be considered in addition to BMI.

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