Will use of the Six-Item Cognitive Impairment Test help to close the dementia diagnosis gap?

ObjectiveTo test diagnostic accuracy of the mini-Addenbrooke's Cognitive Examination (m-ACE) compared to the MMSE for the diagnosis of dementia and MCI in consecutive referrals to a dedicated cognitive disorders clinic.Results: Of 135 consecutive new outpatients seen over 6 months (June–November 2014) administered the mini-ACE (F:M=64:71, 47% female; age range 18–88 years, median 60), 24 were diagnosed with dementia (DSM–IV–TR criteria) and 39 had MCI (Petersen criteria). Using the cutoffs defined in the index paper (≤25/30 and ≤21/30), m-ACE was sensitive (1.00, 0.92) but not specific (0.28, 0.61) for dementia diagnosis; it also proved useful for MCI diagnosis (sensitivities 1.00, 0.77; specificities 0.43, 0.82). Area under the ROC curve was 0.86. Effect size (Cohen's d) for m-ACE for dementia vs. no dementia was 1.53 (large) and for MCI vs no cognitive impairment was 1.59 (large); for MMSE the corresponding figures were 1.56 and 1.26. Weighted comparison suggested a small net loss for m-ACE vs MMSE for dementia diagnosis (–0.13) but a large net benefit for MCI diagnosis (0.38).Conclusions: In this pragmatic study, m-ACE proved quick, easy to use, and acceptable to patients, with metrics comparable to MMSE for dementia diagnosis and better for MCI diagnosis.

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Increases in Neuroticism May Be an Early Indicator of Dementia: A Coordinated Analysis

The Journals of Gerontology Series B ◽

10.1093/geronb/gby034 ◽

2018 ◽

Vol 75 (2) ◽

pp. 251-262 ◽

Cited By ~ 5

Author(s):

Tomiko Yoneda ◽

Jonathan Rush ◽

Eileen K Graham ◽

Anne Ingeborg Berg ◽

Hannie Comijs ◽

...

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Personality Traits ◽

Growth Curve ◽

Personality Change ◽

Dementia Diagnosis ◽

Total N ◽

Growth Curve Models ◽

Aging Study ◽

Early Indication

Abstract Objectives Although personality change is typically considered a symptom of dementia, some studies suggest that personality change may be an early indication of dementia. One prospective study found increases in neuroticism preceding dementia diagnosis (Yoneda, T., Rush, J., Berg, A. I., Johansson, B., & Piccinin, A. M. (2017). Trajectories of personality traits preceding dementia diagnosis. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 72, 922–931. doi:10.1093/geronb/gbw006). This study extends this research by examining trajectories of personality traits in additional longitudinal studies of aging. Methods Three independent series of latent growth curve models were fitted to data from the Longitudinal Aging Study Amsterdam and Einstein Aging Study to estimate trajectories of personality traits in individuals with incident dementia diagnosis (total N = 210), in individuals with incident Mild Cognitive Impairment (N = 135), and in individuals who did not receive a diagnosis during follow-up periods (total N = 1740). Results Controlling for sex, age, education, depressive symptoms, and the interaction between age and education, growth curve analyses consistently revealed significant linear increases in neuroticism preceding dementia diagnosis in both datasets and in individuals with mild cognitive impairment. Analyses examining individuals without a diagnosis revealed nonsignificant change in neuroticism overtime. Discussion Replication of our previous work in 2 additional datasets provides compelling evidence that increases in neuroticism may be early indication of dementia, which can facilitate development of screening assessments.

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Concordance of Clinical Alzheimer Diagnosis and Neuropathological Features at Autopsy

Journal of Neuropathology & Experimental Neurology ◽

10.1093/jnen/nlaa014 ◽

2020 ◽

Vol 79 (5) ◽

pp. 465-473

Author(s):

Kathryn Gauthreaux ◽

Tyler A Bonnett ◽

Lilah M Besser ◽

Willa D Brenowitz ◽

Merilee Teylan ◽

...

Keyword(s):

Cognitive Impairment ◽

Alzheimer Disease ◽

Clinical Diagnosis ◽

Clinical Features ◽

Behavioral Problems ◽

Dementia Diagnosis ◽

Alzheimer Dementia ◽

Severe Cognitive Impairment ◽

Clinical Phenotypes ◽

Clinical Diagnoses

Abstract It remains unclear what clinical features inform the accuracy of a clinical diagnosis of Alzheimer disease (AD). Data were obtained from the National Alzheimer’s Coordinating Center to compare clinical and neuropathologic features among participants who did or did not have Alzheimer disease neuropathologic changes (ADNC) at autopsy. Participants (1854) had a clinical Alzheimer dementia diagnosis and ADNC at autopsy (Confirmed-AD), 204 participants had an AD diagnosis and no ADNC (AD-Mimics), and 253 participants had no AD diagnosis and ADNC (Unidentified-AD). Compared to Confirmed-AD participants, AD-Mimics had less severe cognitive impairment, while Unidentified-AD participants displayed more parkinsonian signs, depression, and behavioral problems. This study highlights the importance of developing a complete panel of biomarkers as a tool to inform clinical diagnoses, as clinical phenotypes that are typically associated with diseases other than AD may result in inaccurate diagnoses.

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Mild Cognitive Impairment and Driving Cessation: A 3-Year Longitudinal Study

Dementia and Geriatric Cognitive Disorders ◽

10.1159/000478740 ◽

2017 ◽

Vol 44 (1-2) ◽

pp. 63-70 ◽

Cited By ~ 7

Author(s):

Michael H. Connors ◽

David Ames ◽

Michael Woodward ◽

Henry Brodaty

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Neuropsychiatric Symptoms ◽

Significant Proportion ◽

Medication Use ◽

Significant Morbidity ◽

Dementia Diagnosis ◽

Driving Cessation ◽

Memory Clinics ◽

And Function

Background/Aims: Driving cessation is associated with significant morbidity in older people. People with mild cognitive impairment (MCI) may be at particular risk of this. Very little research has examined driving in this population. Given this, we sought to identify predictors of driving cessation in people with MCI. Methods: One hundred and eighty-five people with MCI were recruited from 9 memory clinics around Australia. People with MCI and their carers reported their driving status and completed measures of cognition, function, neuropsychiatric symptoms, and medication use at regular intervals over a 3-year period. Results: Of the 144 people still driving at baseline, 50 (27.0%) stopped driving during the study. Older age, greater cognitive and functional impairment, and greater decline in cognition and function at 6 months predicted subsequent driving cessation. Twenty-nine of the 50 people (58%) who stopped driving were diagnosed with dementia during the study; all except one of whom ceased driving after their dementia diagnosis. Conclusion: A significant proportion of people diagnosed with MCI stop driving over the following 3 years. This cannot be entirely attributed to developing dementia. Easily assessable characteristics - such as age, cognition, and function - and changes in these measures over 6 months predict driving cessation.

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Diagnostic Failure of Cognitive Impairment in Nursing Home Residents May Lead to Impaired Medical Care

Dementia and Geriatric Cognitive Disorders ◽

10.1159/000499671 ◽

2019 ◽

Vol 47 (4-6) ◽

pp. 209-218 ◽

Cited By ~ 1

Author(s):

Björn Westerlind ◽

Carl Johan Östgren ◽

Patrik Midlöv ◽

Jan Marcusson

Keyword(s):

Nursing Home ◽

Cognitive Impairment ◽

Medical Care ◽

Nursing Home Residents ◽

Control Group ◽

Cognitively Impaired ◽

Dementia Diagnosis ◽

Laboratory Findings ◽

Group A ◽

The Impact

Background/Objectives: Dementia and cognitive impairment are common in nursing homes. Few studies have studied the impact of unnoted cognitive impairment on medical care. This study aimed to estimate the prevalence of diagnostic failure of cognitive impairment in a sample of Swedish nursing home residents and to analyze whether diagnostic failure was associated with impaired medical care. Method: A total of 428 nursing home residents were investigated during 2008–2011. Subjects without dementia diagnosis were grouped by result of the Mini Mental State Examination (MMSE), where subjects with <24 points formed a possible dementia group and the remaining subjects a control group. A third group consisted of subjects with diagnosed dementia. These three groups were compared according to baseline data, laboratory findings, drug use, and mortality. Results: Dementia was previously diagnosed in 181 subjects (42%). Among subjects without a dementia diagnosis, 72% were cognitively impaired with possible dementia (MMSE <24). These subjects were significantly older, did not get anti-dementia treatment, and had higher levels of brain natriuretic peptide compared to the diagnosed dementia group, but the risks of malnutrition and pressure ulcers were similar to the dementia group. Conclusions: Unnoted cognitive impairment is common in nursing home residents and may conceal other potentially treatable conditions such as heart failure. The results highlight a need to pay increased attention to cognitive impairment among nursing home residents.

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“Even Though I Have Dementia, I Prefer That They Are Personable”: A Qualitative Focused Ethnography Study in a Danish General Hospital Setting

Global Qualitative Nursing Research ◽

10.1177/2333393619899388 ◽

2020 ◽

Vol 7 ◽

pp. 233339361989938 ◽

Cited By ~ 1

Author(s):

Annemarie Toubøl ◽

Lene Moestrup ◽

Jesper Ryg ◽

Katja Thomsen ◽

Dorthe Susanne Nielsen

Keyword(s):

Cognitive Impairment ◽

Data Collection ◽

General Hospital ◽

Patient Perspective ◽

Analytical Approach ◽

Hospital Setting ◽

Hospital Staff ◽

Focused Ethnography ◽

Dementia Diagnosis

Patients with dementia often face challenges in hospital settings due to cognitive impairment. The aim of this study is to explore the encounter between patients with dementia and hospital staff, from the patient perspective. Focused ethnography guided the method for data collection and the analytical approach was abductive. The findings, based on 10 observations of patients with dementia and their encounter with hospital staff in a variety of hospital settings, reveal that staff often seem to not see the person beyond the dementia diagnosis. The findings also show, however, that significant moments are constantly negotiated during encounters between patients with dementia and hospital staff, moments which occasionally allow staff to see the patients to be seen as the person they are. A rethinking of the current dementia discourse is discussed, recommending attention to the two-way interaction between patients with dementia and hospital staff, and within this an awareness of a personable approach.

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Factors associated with slow progression of cognitive impairment following first dementia diagnosis

International Journal of Geriatric Psychiatry ◽

10.1002/gps.5420 ◽

2020 ◽

Author(s):

Gayan Perera ◽

Christoph Mueller ◽

Robert Stewart

Keyword(s):

Cognitive Impairment ◽

Dementia Diagnosis ◽

Factors Associated ◽

Slow Progression

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A U.S. NATIONAL PROFILE OF OLD ADULTS WITH COGNITIVE IMPAIRMENT ALONE, PHYSICAL FRAILTY ALONE, AND BOTH

Innovation in Aging ◽

10.1093/geroni/igz038.1467 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S397-S397

Author(s):

Meiling Ge ◽

Qianli Xue

Keyword(s):

Cognitive Impairment ◽

Test Performance ◽

Smoking Status ◽

Current Smoker ◽

Dementia Diagnosis ◽

Physical Frailty ◽

Proxy Report ◽

Old Adults ◽

Using Data ◽

National Profile

Abstract Using data from NHATS, we aimed to identify characteristics (demographics, health conditions/events, self-care behaviors, psychological wellbeing) that distinguish joint vs. separate presence of physical frailty (by the Fried’s) and cognitive impairment (CI: bottom quintile of test performance in executive function and memory; or proxy-report of dementia diagnosis or AD8 score >=2). Of the 7,497 older adults, 25.5%, 5.6%, and 8.7% had CI only, frailty only, and both, respectively. After adjusting for demographic characteristics, current smoker, single disease, and knee surgery history uniquely identified “frailty only”. Although none was found to uniquely identify “CI only” or “both”, surgery history and comorbidity were strongly associated with “frailty only” and, to a lesser degree, “both”, but not “CI only”. The findings advocate for treating physical frailty and CI as overlapping yet distinct conditions, and prioritizing comorbidity, surgery history, and smoking status in clinical screening of frailty and CI before formal diagnostic assessments.

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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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