Author:

Keywords:

Age Distribution, Aged, Aged, 80 and over, Cross-Sectional Studies, Dementia, Family Practice, Female, Humans, Logistic Models, Male, Neuropsychological Tests, Sensitivity and Specificity, Science & Technology, Life Sciences & Biomedicine, Health Care Sciences & Services, Public, Environmental & Occupational Health, diagnosis, dementia, general practice, family medicine, sensitivity, specificity, MINI-MENTAL-STATE, ALZHEIMERS-DISEASE, PRIMARY-CARE, STANDARDIZED INSTRUMENT, COMPUTERIZED ASSESSMENT, GENERAL-PRACTITIONERS, EXTRAPYRAMIDAL SIGNS, COGNITIVE IMPAIRMENT, ACCURACY, MANAGEMENT, 01 Mathematical Sciences, 11 Medical and Health Sciences, Epidemiology, 4202 Epidemiology

Abstract:

OBJECTIVE: To study the diagnostic parameters of a number of instruments for a diagnosis of dementia in general practice and the added diagnostic value of these tests. STUDY DESIGN AND SETTING: Cross-sectional diagnostic research in general practice. Participants: 152 persons aged 65 plus. The Mini-Mental State Examination (MMSE), the Clock Drawing Test, the ADMP scale, the Timed Up and Go Test, the Extrapyramidal Sign Scale, the Behavior Observation Scale, the Poon-Baro-Wens computer battery, and the Cognitive Drug Research Computerized Assessment System were evaluated against the Dutch version of the Cambridge Examination for Mental Disorders of the Elderly (CAMDEX-N). Diagnostic characteristics were calculated with their 95% CI. Using forward stepwise logistic regression analysis, a model was built with CAMDEX-N as the dependent variable and the tests under study as independent variables. Area under the curve was the main parameter for the comparisons. RESULTS: The main diagnostic gain results from age and ADMP, followed by the Clock Drawing Test. Subsequent addition of the MMSE and computer tests results in modest additional gain only. The final model including five tests has an area under the curve of 0.95. CONCLUSION: Sophisticated neuropsychological computerized tests have little added value in the diagnostic work-up of dementia in general practice. Basic clinical tests used in an appropriate sequence can be very valuable in establishing the diagnosis of dementia.