title: Detection of dementia in primary care: comparison of the original and a modified Mini-Cog Assessment with the Mini-Mental State Examination.
abstract: Background Dementia is considered widely under-detected in primary care, and general practitioners (GPs) frequently ask for easy to use tools to assist in its early detection.Aim To determine the degree of correlation between the Mini-Cog Assessment (Mini-Cog) as performed by GPs and the Mini-Mental State Examination (MMSE).Design of study This was a prospective study (2005, 2006) comparing two cognitive screening instruments.Setting Ten general practices in Austria, with patients with a hitherto undiagnosed suspicion of dementia seen consecutively.Method Sensitivity, specificity and positive and negative predictive values (PPVs and NPVs) of the Mini-Cog (applying both a colour-coded and the original rating method) were assessed for degree of correlation with the MMSE. In phase one GPs examined patients suspected of having dementia using the Mini-Cog; in phase two a neurologist retested them applying the MMSE, a clock-drawing test (CDT) and a routine clinical examination. A questionnaire on the practicability of the Mini-Cog was answered by GPs.Results Of the 107 patients who participated 86 completed the whole study protocol. The Mini-Cog, as performed by the ten GPs, displayed a sensitivity of 0.85 (95% CI: 0.71, 0.98), a specificity of 0.58 (95% CI: 0.46, 0.71), a PPV of 0.47 (95% CI: 0.33, 0.61) and an NPV of 0.90 (95% CI: 0.80, 0.99) as against the MMSE carried out by neurologists. The GPs judged the Mini-Cog useful and time saving.Conclusion The Mini-Cog has a high sensitivity and acceptable specificity in the general practice setting and has proved to be a practicable tool for the diagnosis of dementia in primary care.
authors.affiliation: Department of General Practice, Centre for Public Health, Medical University, Vienna, Austria.
authors.forename: Gustav
authors.initials: G
authors.lastname: Kamenski
authors.forename: Thomas
authors.initials: T
authors.lastname: Dorner
authors.forename: Kitty
authors.initials: K
authors.lastname: Lawrence
authors.forename: Georg
authors.initials: G
authors.lastname: Psota
authors.forename: Anita
authors.initials: A
authors.lastname: Rieder
authors.forename: Franz
authors.initials: F
authors.lastname: Schwarz
authors.forename: Asita
authors.initials: A
authors.lastname: Sepandj
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Spiegel
authors.forename: Stefan
authors.initials: S
authors.lastname: Strotzka