title: The Rapid Cognitive Screen (RCS): A Point-of-Care Screening for Dementia and Mild Cognitive Impairment.
abstract: OBJECTIVE
  There is a need for a rapid screening test for mild cognitive impairment (MCI) and dementia to be used by primary care physicians. The Rapid Cognitive Screen (RCS) is a brief screening tool (< 3 min) for cognitive dysfunction. RCS includes 3-items from the Veterans Affairs Saint Louis University Mental Status (SLUMS) exam: recall, clock drawing, and insight. Study objectives were to: 1) examine the RCS sensitivity and specificity for MCI and dementia, 2) evaluate the RCS predictive validity for nursing home placement and mortality, and 3) compare the RCS to the clock drawing test (CDT) plus recall.
  
  
  METHODS
  Patients were recruited from the St. Louis, MO Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Medical Center (VAMC) hospitals (study 1) or the Saint Louis University Geriatric Medicine and Psychiatry outpatient clinics (study 2). Study 1 participants (N=702; ages 65-92) completed cognitive evaluations and 76% (n=533/706) were followed up to 7.5 years for nursing home placement and mortality. Receiver operator characteristic (ROC) curves were computed to determine sensitivity and specificity for MCI (n=180) and dementia (n=82). Logistic regressions were computed for nursing home placement (n=31) and mortality (n=176). Study 2 participants (N=168; ages 60-90) completed the RCS and SLUMS exam. ROC curves were computed to determine sensitivity and specificity for MCI (n=61) and dementia (n=74).
  
  
  RESULTS
  RCS predicted dementia and MCI in study 1 with optimal cutoff scores of ≤ 5 for dementia (sensitivity=0.89, specificity=0.94) and ≤ 7 for MCI (sensitivity=0.87, specificity=0.70). The CDT plus recall predicted dementia and MCI in study 1 with optimal cutoff scores of ≤ 2 for dementia (sensitivity=0.87, specificity=0.85) and ≤ 3 for MCI (sensitivity=0.62, specificity=0.62). Higher RCS scores were protective against nursing home placement and mortality. The RCS predicted dementia and MCI in study 2.
  
  
  CONCLUSIONS
  The 3-item RCS exhibits good sensitivity and specificity for the detection of MCI and dementia, and higher cognitive function on the RCS is protective against nursing home placement and mortality. The RCS may be a useful screening instrument for the detection of cognitive dysfunction in the primary care setting.
authors.affiliation: Theodore K. Malmstrom, PhD, Department of Neurology and Psychiatry, School of Medicine, Saint Louis University, 1438 South Grand Boulevard, St. Louis, Missouri 63104, Email: malmsttk@slu.edu; Phone: 314-977-4814; Fax: 314-977-4879.
authors.forename: T K
authors.initials: TK
authors.lastname: Malmstrom
authors.forename: V B
authors.initials: VB
authors.lastname: Voss
authors.forename: D M
authors.initials: DM
authors.lastname: Cruz-Oliver
authors.forename: L A
authors.initials: LA
authors.lastname: Cummings-Vaughn
authors.forename: N
authors.initials: N
authors.lastname: Tumosa
authors.forename: G T
authors.initials: GT
authors.lastname: Grossberg
authors.forename: J E
authors.initials: JE
authors.lastname: Morley
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition; D060825:Cognitive Dysfunction / Q000175:diagnosis* / Q000401:mortality; D003704:Dementia / Q000175:diagnosis* / Q000401:mortality; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D016015:Logistic Models; D008297:Male; D011939:Mental Recall; D008875:Middle Aged; D009735:Nursing Homes; D019095:Point-of-Care Systems; D011320:Primary Health Care / Q000379:methods; D012372:ROC Curve; D012680:Sensitivity and Specificity; D013997:Time Factors