title: BrainCheck - a very brief tool to detect incipient cognitive decline: optimized case-finding combining patient- and informant-based data.
abstract: BACKGROUND
  Optimal identification of subtle cognitive impairment in the primary care setting requires a very brief tool combining (a) patients' subjective impairments, (b) cognitive testing, and (c) information from informants. The present study developed a new, very quick and easily administered case-finding tool combining these assessments ('BrainCheck') and tested the feasibility and validity of this instrument in two independent studies.
  
  
  METHODS
  We developed a case-finding tool comprised of patient-directed (a) questions about memory and depression and (b) clock drawing, and (c) the informant-directed 7-item version of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Feasibility study: 52 general practitioners rated the feasibility and acceptance of the patient-directed tool. Validation study: An independent group of 288 Memory Clinic patients (mean ± SD age = 76.6 ± 7.9, education = 12.0 ± 2.6; 53.8% female) with diagnoses of mild cognitive impairment (n = 80), probable Alzheimer's disease (n = 185), or major depression (n = 23) and 126 demographically matched, cognitively healthy volunteer participants (age = 75.2 ± 8.8, education = 12.5 ± 2.7; 40% female) partook. All patient and healthy control participants were administered the patient-directed tool, and informants of 113 patient and 70 healthy control participants completed the very short IQCODE.
  
  
  RESULTS
  Feasibility study: General practitioners rated the patient-directed tool as highly feasible and acceptable. Validation study: A Classification and Regression Tree analysis generated an algorithm to categorize patient-directed data which resulted in a correct classification rate (CCR) of 81.2% (sensitivity = 83.0%, specificity = 79.4%). Critically, the CCR of the combined patient- and informant-directed instruments (BrainCheck) reached nearly 90% (that is 89.4%; sensitivity = 97.4%, specificity = 81.6%).
  
  
  CONCLUSIONS
  A new and very brief instrument for general practitioners, 'BrainCheck', combined three sources of information deemed critical for effective case-finding (that is, patients' subject impairments, cognitive testing, informant information) and resulted in a nearly 90% CCR. Thus, it provides a very efficient and valid tool to aid general practitioners in deciding whether patients with suspected cognitive impairments should be further evaluated or not ('watchful waiting').
authors.affiliation: Memory Clinic, University Center for Medicine of Aging Basel, Felix Platter-Spital, Schanzenstrasse 55, 4031 Basel, Switzerland.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Ehrensperger
authors.affiliation: Memory Clinic, University Center for Medicine of Aging Basel, Felix Platter-Spital, Schanzenstrasse 55, 4031 Basel, Switzerland ; Centre for Speech, Language and the Brain, Department of Psychology, University of Cambridge, Downing Street, Cambridge, CB2 3EB UK.
authors.forename: Kirsten I
authors.initials: KI
authors.lastname: Taylor
authors.affiliation: Department of Mathematics and Technology, University of Applied Sciences, Koblenz, Joseph-Rovan-Allee 2, 53424 Remagen, Germany.
authors.forename: Manfred
authors.initials: M
authors.lastname: Berres
authors.affiliation: Department of Psychology, Queens College and The Graduate Center of The City University of New York, 65-30 Kissena Blvd., NSB-E318, Flushing, NY 11367 USA.
authors.forename: Nancy S
authors.initials: NS
authors.lastname: Foldi
authors.affiliation: Center for Gerontology, University of Zurich, Sumatrastrasse 30, 8006 Zurich, Switzerland ; Currently: Center for Medical Education, Max-Daetwyler-Platz 2, 3014 Berne, Switzerland.
authors.forename: Myriam
authors.initials: M
authors.lastname: Dellenbach
authors.affiliation: Department of Geriatrics, Town Hospital Waid, Tièchestrasse 99, 8037 Zurich, Switzerland.
authors.forename: Irene
authors.initials: I
authors.lastname: Bopp
authors.affiliation: Department of Internal Medicine, Rehabilitation and Geriatrics, University of Geneva, Ch. du Pont-Bochet 3, 1226 Thônex, Switzerland.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Gold
authors.affiliation: Department of Old Age Psychiatry, University of Lausanne, Route du Mont, 1008 Prilly, Switzerland.
authors.forename: Armin
authors.initials: A
authors.lastname: von Gunten
authors.affiliation: Department of Geriatrics, General Hospital, Rorschacher Strasse 94, 9000 St. Gallen, Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Inglin
authors.affiliation: Department of Neurology, University Hospital, Inselspital, 3010 Berne, Switzerland.
authors.forename: René
authors.initials: R
authors.lastname: Müri
authors.affiliation: Department of Geriatrics, Town Hospital Waid, Tièchestrasse 99, 8037 Zurich, Switzerland.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Rüegger
authors.affiliation: University Center for Medicine of Aging Basel, Felix Platter-Spital, Burgfelderstrasse 101, 4055 Basel, Switzerland.
authors.forename: Reto W
authors.initials: RW
authors.lastname: Kressig
authors.affiliation: Memory Clinic, University Center for Medicine of Aging Basel, Felix Platter-Spital, Schanzenstrasse 55, 4031 Basel, Switzerland.
authors.forename: Andreas U
authors.initials: AU
authors.lastname: Monsch