Development and validation of a brief dementia screening indicator for primary care.
BACKGROUND
Detection of "any cognitive impairment" is mandated as part of the Medicare annual wellness visit, but screening all patients may result in excessive false positives.


METHODS
We developed and validated a brief Dementia Screening Indicator using data from four large, ongoing cohort studies (the Cardiovascular Health Study [CHS]; the Framingham Heart Study [FHS]; the Health and Retirement Study [HRS]; the Sacramento Area Latino Study on Aging [SALSA]) to help clinicians identify a subgroup of high-risk patients to target for cognitive screening.


RESULTS
The final Dementia Screening Indicator included age (1 point/year; ages, 65-79 years), less than 12 years of education (9 points), stroke (6 points), diabetes mellitus (3 points), body mass index less than 18.5 kg/m(2) (8 points), requiring assistance with money or medications (10 points), and depressive symptoms (6 points). Accuracy was good across the cohorts (Harrell's C statistic: CHS, 0.68; FHS, 0.77; HRS, 0.76; SALSA, 0.78).


CONCLUSIONS
The Dementia Screening Indicator is a simple tool that may be useful in primary care settings to identify high-risk patients to target for cognitive screening.
Department of Psychiatry, University of California, San Francisco, CA, USA; Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA; Veterans Affairs Medical Center, San Francisco, CA, USA. Electronic address: Deborah.barnes@ucsf.edu.
Deborah E
DE
Barnes
Department of Neurology, Boston University, Boston, MA, USA; Department of Biostatistics, Boston University, Boston, MA, USA.
Alexa S
AS
Beiser
Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA.
Anne
A
Lee
Institute for Social Research, University of Michigan, Ann Arbor, MI, USA; Department of Medicine, University of Michigan, Ann Arbor, MI, USA; Veterans Affairs Center for Practice Management and Outcomes Research, Ann Arbor, MI, USA.
Kenneth M
KM
Langa
Northern California Institute for Research and Education, San Francisco, CA, USA.
Alain
A
Koyama
Department of Neurology, Boston University, Boston, MA, USA.
Sarah R
SR
Preis
Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA.
John
J
Neuhaus
Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.
Ryan J
RJ
McCammon
Department of Psychiatry, University of California, San Francisco, CA, USA; Department of Neurology, University of California, San Francisco, CA, USA; Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA; Veterans Affairs Medical Center, San Francisco, CA, USA.
Kristine
K
Yaffe
Department of Neurology, Boston University, Boston, MA, USA; Department of Biostatistics, Boston University, Boston, MA, USA.
Sudha
S
Seshadri
Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA.
Mary N
MN
Haan
Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.
David R
DR
Weir
D000368:Aged; D015331:Cohort Studies; D003704:Dementia / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D011237:Predictive Value of Tests; D011320:Primary Health Care; D016016:Proportional Hazards Models; D018570:Risk Assessment
Dementia; Primary care; Risk prediction modeling; Screening