A cost-effective approach of identifying community-dwelling elders with possible dementia through periodic mini-cog screening
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AIM: There has been ongoing debate over the real benefits and cost-worthiness of dementia screening especially targeting elders living in the community and without obvious symptoms1,2. Dementia screening tests even with high specificity, may still generate a significant number of false positives in a low-prevalence population3. Apart from causing unnecessary distress in both patients and their families, false positives could also lead to additional cost and misuse of professional resources due to avoidable diagnostic workups4. An objective of this study was to explore the benefits of a periodic screening model, with the Mini-Cog as the screening tool, in minimizing the possibility of generating false-positives.
METHOD: 96 non-clinical community-dwelling Chinese elders in Toronto, age ranged from 65-94, were recruited for the study. Research participants were screened for possible dementia by the Mini-Cog (sensitivity=0.91; specificity=0.86)5 repeatedly at 3 consecutive times and the interval between each screening round was 4-month. The rate of detection in each screening round was recorded, and participants’ consistency of having positive-screen in all screening rounds was evaluated.
RESULTS: Of the 96 Chinese elders who received the 1st round screening, 35 (36%) were screen-positives. 78 (81%) of the recruited participants entered into the 2nd round of screening, of those, 25 (32%) were having a positive-screen. In the 3rd round, there were 73 (76% of the 1st round participants) being tested by the Mini-Cog, and of those, 26 (36%) were screen-positives. By combining the results of the 3 consecutive screenings, there were 13 (19% of the 73) who were consistently found to be screen-positives and should warrant diagnostic workups. The net sensitivity of the periodic screening was 0.75, and the net specificity was 0.99.
CONCLUSION: A periodic screening model involving lay-interviewers and employing a brief, easy-to-use and inexpensive screening instrument may be a cost-effective solution for community-based dementia screening.

1. Fox, C., Lafortune, L., Boustani, M., & Brayne, C. (2013). The pros and cons of early diagnosis in dementia. British Journal of General Practice, 63(612), e510-e512.

2. Moyer, V. A. (2012). Screening for prostate cancer: US Preventive Services Task Force recommendation statement. Annals of internal medicine, 157(2), 120-134.

3. Akobeng, A. K. (2007). Understanding diagnostic tests 1: sensitivity, specificity and predictive values. Acta paediatrica, 96(3), 338-341.

4. Borson, S., Frank, L., Bayley, P. J., Boustani, M., Dean, M., Lin, P. J., McCarten, J.R., et al. (2013). Improving dementia care: the role of screening and detection of cognitive impairment. Alzheimer's & Dementia, 9(2), 151-159.

5. Tsoi, K. K., Chan, J. Y., Hirai, H. W., Wong, S. Y., & Kwok, T. C. (2015). Cognitive tests to detect dementia: a systematic review and meta-analysis. JAMA internal medicine, 175(9), 1450-1458.
All Author(s) ListKar Choi CHAN, Joel Sadavoy
Name of ConferenceThe Royal Australian and New Zealand College of Psychiatrists (RANZCP) 2016 New Zealand Conference
Start Date of Conference12/10/2016
End Date of Conference14/10/2016
Place of ConferenceChristchurch
Country/Region of ConferenceNew Zealand
LanguagesEnglish-United Kingdom
KeywordsPeriodic Screening, Mini-Cog, Dementia, Community-dwelling Elders

Last updated on 2021-07-05 at 11:19