title: Residential care/assisted living staff may detect undiagnosed dementia using the minimum data set cognition scale.
abstract: OBJECTIVE
  To estimate the sensitivity, specificity, and reliability of the Minimum Data Set Cognition Scale (MDS-COGS) in screening for undetected dementia when completed by direct care staff in residential care/assisted living (RC/AL) facilities and secondarily to determine the prevalence of dementia in the sample.
  
  
  METHODS
  A cross-sectional study in which staff were trained to complete the MDS-COGS. Research interviewers and a neuropsychologist obtained information on each participant. Two neurologists reviewed the data and examined the participant, rendering a probable diagnosis of dementia/non-dementia diagnosis. MDS-COGS results were compared with the neurologists' determination.
  
  
  METHODS
  Fourteen RC/AL facilities in North Carolina.
  
  
  METHODS
  Data were collected from 50 staff on 166 residents without a diagnosis of dementia.
  
  
  METHODS
  In addition to the MDS-COGS, measures included a comprehensive neuropsychological battery. Depression and other neuropsychiatric symptoms were also assessed.
  
  
  RESULTS
  Neurologists determined that 38% of participants had probable dementia. An MDS-COGS cutpoint of 2 was highly specific (0.97) but not very sensitive (0.49) for dementia. Test-retest and interrater agreement for a negative screen were high (88% and 93%, respectively).
  
  
  CONCLUSIONS
  The MDS-COGS is a simple, brief screen that RC/AL staff can complete. It will identify with high specificity a subset of residents with undetected dementia, allowing rapid identification of those likely to need dementia care. Caution needs to be exercised in light of its low sensitivity, because some with milder dementia will not be detected. Further work is needed to determine whether staff can and will use the MDS-COGS as a trigger for more-thorough assessment and to guide care and improve outcomes.
authors.affiliation: Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7590, USA. sheryl_zimmerman@unc.edu
authors.forename: Sheryl
authors.initials: S
authors.lastname: Zimmerman
authors.forename: Philip D
authors.initials: PD
authors.lastname: Sloane
authors.forename: Christianna S
authors.initials: CS
authors.lastname: Williams
authors.forename: Debra
authors.initials: D
authors.lastname: Dobbs
authors.forename: Ratnavalli
authors.initials: R
authors.lastname: Ellajosyula
authors.forename: Alyssa
authors.initials: A
authors.lastname: Braaten
authors.forename: Marcia F T
authors.initials: MF
authors.lastname: Rupnow
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Kaufer
mesh_terms: D000369:Aged, 80 and over; D040561:Assisted Living Facilities; D003071:Cognition / Q000502:physiology*; D003430:Cross-Sectional Studies; D003704:Dementia / Q000175:diagnosis* / Q000523:psychology; D003937:Diagnosis, Differential; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008503:Medical Staff; D011569:Psychiatric Status Rating Scales / Q000592:standards*; D012372:ROC Curve