title: CAMDEX, can it be more efficient? Observational study on the contribution of four screening measures to the diagnosis of dementia by a memory clinic team.
abstract: OBJECTIVE
  To evaluate the efficiency of the CAMDEX by exploring the contribution of its four main screening measures to the diagnosis of dementia at a memory clinic.
  
  
  METHODS
  A retrospective descriptive study was conducted on the diagnostic practice in a memory clinic regarding all consecutively referred patients who came for a first assessment. A standardised examination based on the CAMDEX included three cognitive tests (CAMCOG, MMSE, IMCT) and a test for functional competence (BDS). The predictive value of the tests was estimated by uni- and multivariate analysis with the clinical dementia diagnosis (yes/no) as dependent variable, taking into account the patients' age, education, gender and sensory ability.
  
  
  RESULTS
  Of the 180 patients consecutively referred, 150 completed the assessments and entered the study. Multivariate analysis revealed that the CAMCOG-score contributed most to the clinical diagnosis and was consistent with 84% of the clinical diagnoses using the conventional cutoff 79/80. The CAMCOG-score correlated best with the clinical diagnosis, however, at a cutoff score of 81/82. Forty-one patients (27%) scored closely around (+/-5 points) the CAMCOG cutoff of 79/80. In this group 19 of the total of 23 deviations from the CAMCOG cutoff (83%) occurred. The patients' age, education, gender and visual ability explained some cases where the team's diagnosis deviated from the conventional cutoff score.
  
  
  CONCLUSIONS
  Among four screening measures, after control, the CAMCOG was the only significant predictor for the clinical diagnosis of dementia. To gain efficiency, the screening measures of the CAMDEX protocol may be restricted to the CAMCOG. The interpretation of CAMCOG-scores around the cut-off is problematic. This indicates the need for reference values.
authors.affiliation: Department of Geriatric Medicine, P.O. Box 9101, Academic Hospital St Radboud, 6500 HB Nijmegen, The Netherlands. h.vanhout@ihf.nl
authors.forename: H
authors.initials: H
authors.lastname: van Hout
authors.forename: S
authors.initials: S
authors.lastname: Teunisse
authors.forename: M
authors.initials: M
authors.lastname: Derix
authors.forename: P
authors.initials: P
authors.lastname: Poels
authors.forename: Y
authors.initials: Y
authors.lastname: Kuin
authors.forename: M
authors.initials: M
authors.lastname: Vernooij-Dassen
authors.forename: R
authors.initials: R
authors.lastname: Grol
authors.forename: W
authors.initials: W
authors.lastname: Hoefnagels
mesh_terms: D000368:Aged; D003072:Cognition Disorders / Q000175:diagnosis / Q000523:psychology; D003704:Dementia / Q000175:diagnosis*; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D008403:Mass Screening; D008569:Memory Disorders / Q000175:diagnosis / Q000523:psychology; D008875:Middle Aged; D011594:Psychometrics; D012680:Sensitivity and Specificity