The comparative diagnostic accuracy of the Mini Mental State Examination (MMSE) and the General Practitioner assessment of Cognition (GPCOG) for identifying dementia in primary care: a systematic review protocol

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Considerations and design on apps for elderly with mild-to-moderate dementia

Many elderly people suffer from dementia in their daily life. The symptoms of dementia include impairments in thinking, communicating and recalling things of the past. Dementia can be caused by brain damage incurred from stroke (brain infarct), injury or other diseases. Recently, research has indicated a potential rehabilitative role for touchscreen technology in dementia. Elders can use apps to aid recall in order to support activities of daily living. Memory and activity apps can be developed for people suffering from early dementia. This paper presents the current state of development in the field of cognitive tests. It has also presented the many considerations and design issues related to the development of apps for people with dementia. © 2015 IEEE.published_or_final_versio

Cost effectiveness of using cognitive screening tests for detecting dementia and mild cognitive impairment in primary care.

INTRODUCTION: We estimated the cost effectiveness of different cognitive screening tests for use by General Practitioners (GPs) to detect cognitive impairment in England. METHODS: A patient-level cost-effectiveness model was developed using a simulated cohort that represents the elderly population in England (65 years and older). Each patient was followed over a lifetime period. Data from published sources were used to populate the model. The costs include government funded health and social care, private social care and informal care. Patient health benefit was measured and valued in Quality Adjusted Life Years (QALYs). RESULTS: Base-case analyses found that adopting any of the three cognitive tests (Mini-Mental State Examination, 6-Item Cognitive Impairment Test or GPCOG (General Practitioner Assessment of Cognition)) delivered more QALYs for patients over their lifetime and made savings across sectors including healthcare, social care and informal care compared with GP unassisted judgement. The benefits were due to early access to medications. Among the three cognitive tests, adopting the GPCOG was considered the most cost-effective option with the highest Incremental Net Benefit (INB) at the threshold of £30 000 per QALY from both the National Health Service and Personal Social Service (NHS PSS) perspective (£195 034 per 1000 patients) and the broader perspective that includes private social care and informal care (£196 251 per 1000 patients). Uncertainty was assessed in both deterministic and probabilistic sensitivity analyses. CONCLUSIONS: Our analyses indicate that the use of any of the three cognitive tests could be considered a cost-effective strategy compared with GP unassisted judgement. The most cost-effective option in the base-case was the GPCOG. Copyright © 2016 John Wiley & Sons, Ltd

Creating a leaflet about dementia case finding

To create a leaflet for GPs about the “case finding” of people in the DES “facilitating timely diagnosis and support for people with dementia,” within 4 weeks using email to link a newly formed group. Questions we asked were: How reliable is the GPCog screening tool? What is the natural history of Mild Cognitive Impairment (MCI)? What are patient benefits of early therapy? A literature review and email discussion ensued. The main findings were: Positive predictive value of GPCog is 71% so an abnormal score does not indicate definite dementia Not every memory loss is dementia; not every dementia is Alzheimer’s Pathological features of Alzheimer’s may be present in normally ageing brains A review of attendees at a memory clinic: >50% had not got dementia or MCI. 27% had “benign memory complaints” Patients with MCI - 20% develop dementia at 5 years. Rates of conversion of MCI to dementia vary between 11-33% at 2 years 42% of patients with MCI have remitting symptoms, with normal cognition at 1.5 and 3 years There is no current benefit of early therapy with cholinesterase inhibitors in MCI at 1, 2 or 3 year

An investigation of social activities of neurologically healthy older adults and relevance of the Social Activities Checklist (SOCACT-2)

Purpose: This preliminary study aimed to describe the type, range, partner and frequency of social activity among neurologically healthy older people in order to evaluate the content validity of the SOCial ACTivities Checklist (SOCACT-2). Method: Ten neurologically healthy older people were recruited. Participants’ social activities were investigated through the completion of the SOCACT-2. Naturalistically occurring social activities were then recorded in a social activity diary over 28 consecutive days. Items recorded in the diaries were compared with SOCACT-2 items, and new items not included in the SOCACT-2 were noted. Frequency and location of participation was also recorded. Results: All SOCACT-2 items were recorded in the diaries, with the exception of two. Findings suggest that another two SOCACT-2 items could be rephrased to more accurately reflect naturalistically occurring social activities, and two new categories of social activities were identified. Conclusions: The results provide preliminary evidence for the relevance of the majority of SOCACT items. Revisions to four existing items included in the SOCACT-2, as well as the inclusion of two additional items may be indicated to capture the range of activities participated in by older people

Dementia and primary health care

Dementia care is becoming increasingly relevant in Australia as our population ages, presenting challenges for an already stretched health system. General practitioners are the first port of call in dementia identification and care, and are the coordinators of dementia identification and management. There is increasing involvement of practice nurses in these processes. Carers and many health professionals believe early diagnosis is critical, though GPs report diagnosing only for functional necessity such as to prescribe medication. Referrals for carers to information and support services are often delayed until carers reach ‘breaking point’, highlighting the need for anticipatory referral processes. Carers are often called the ‘hidden patients’ as they suffer from higher physical and mental illness resulting from caregiver burden

Cognitive and mood assessment tools for use in stroke

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Validation of the Greek translation of the cognitive disorders examination (Codex) for the detection of dementia in primary care

OBJECTIVE: To validate the Greek translation of the Cognitive Disorders Examination (Codex) and to investigate its potential for implementation for the detection of dementia in the Greek population. / METHOD: Subjects aged ≥60 years with and without dementia, based on the diagnostic criteria DSM-IV-TR, were included in the study. Translation of the test Codex from French to Greek and back-translation from Greek to French were conducted to verify the validity of the translation. The Greek version of the Codex and the Mini Mental State Examination (MMSE) were administered to 17 patients with dementia and 27 patients without dementia. / RESULTS: The median age of the participants was 82 years (range 61–93 years) for patients with dementia and 73 years (range 61–84 years) for patients without dementia. The average level of education was 9.0 years (range 2–20 years) for patients with dementia and 10.5 years (range 3–16 years) for those without. The average score on the MMSE was 15.7 (range 7–27) for patients with dementia and 28.3 (range 25–30) for those without dementia. The sensitivity of Codex for the detection of dementia was 94.1% and its specificity was 88.9%. / CONCLUSIONS: The Greek version of Codex can detect dementia reliably. Its validation as a diagnostic tool for use in the Greek population will require testing on a larger sample of individuals