title: Using temporal orientation, category fluency, and word recall for detecting cognitive impairment: the 10-point cognitive screener (10-CS).
abstract: OBJECTIVE
  A screening strategy composed of three-item temporal orientation and three-word recall has been increasingly used for detecting cognitive impairment. However, the intervening task administered between presentation and recall has varied. We evaluated six brief tasks that could be useful as intervening distractors and possibly provide incremental accuracy: serial subtraction, clock drawing, category fluency, letter fluency, timed visual detection, and digits backwards.
  
  
  METHODS
  Older adults (n = 230) consecutively referred for suspected cognitive impairment underwent a comprehensive assessment for gold-standard diagnosis, of whom 56 (24%) presented cognitive impairment not dementia and 68 (30%) presented dementia. Among those with dementia, 87% presented very mild or mild stages (Clinical Dementia Rating 0.5 or 1). The incremental value of each candidate intervening task in a model already containing orientation and word recall was assessed.
  
  
  RESULTS
  Category fluency (animal naming) presented the highest incremental value among the six candidate intervening tasks. Reclassification analyses revealed a net gain of 12% among cognitively impaired and 17% among normal participants. A four-point scaled score of the animal naming task was added to three-item temporal orientation and three-word recall to compose the 10-point Cognitive Screener. The education-adjusted 10-point Cognitive Screener outperformed the longer Mini-Mental State Examination for detecting both cognitive impairment (area under the curve 0.85 vs 0.77; p = 0.027) and dementia (area under the curve 0.90 vs 0.83; p = 0.015).
  
  
  CONCLUSIONS
  Based on empirical data, we have developed a brief and easy-to-use screening strategy with higher accuracy and some practical advantages compared with commonly used tools.
authors.affiliation: Division of Geriatrics, Department of Internal Medicine, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Daniel
authors.initials: D
authors.lastname: Apolinario
authors.affiliation: Division of Geriatrics, Department of Internal Medicine, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Daniel Gomes
authors.initials: DG
authors.lastname: Lichtenthaler
authors.affiliation: Division of Geriatrics, Department of Internal Medicine, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Regina Miksian
authors.initials: RM
authors.lastname: Magaldi
authors.affiliation: Division of Geriatrics, Department of Internal Medicine, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Aline Thomaz
authors.initials: AT
authors.lastname: Soares
authors.affiliation: Division of Geriatrics, Department of Internal Medicine, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Alexandre Leopold
authors.initials: AL
authors.lastname: Busse
authors.affiliation: Division of Geriatrics, Department of Internal Medicine, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Jose Renato das Gracas
authors.initials: JR
authors.lastname: Amaral
authors.affiliation: Division of Geriatrics, Department of Internal Medicine, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Wilson
authors.initials: W
authors.lastname: Jacob-Filho
authors.affiliation: Division of Behavioral and Cognitive Neurology, Department of Neurology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Sonia Maria Dozzi
authors.initials: SM
authors.lastname: Brucki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000175:diagnosis* / Q000503:physiopathology; D003704:Dementia / Q000175:diagnosis*; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D011939:Mental Recall / Q000502:physiology*; D009483:Neuropsychological Tests / Q000592:standards*; D012372:ROC Curve; D013998:Time Perception / Q000502:physiology*
keywords: dementia; memory; mild cognitive impairment; orientation; screening; verbal fluency