title: Case-finding for cognitive impairment among people with Type 2 diabetes in primary care using the Test Your Memory and Self-Administered Gerocognitive Examination questionnaires: the Cog-ID study.
abstract: To evaluate two cognitive tests for case-finding for cognitive impairment in older patients with Type 2 diabetes.
  
  
  
  Of 1243 invited patients with Type 2 diabetes, aged ≥70 years, 228 participated in a prospective cohort study. Exclusion criteria were: diagnosis of dementia; previous investigation at a memory clinic; and inability to write or read. Patients first filled out two self-administered cognitive tests (Test Your Memory and Self-Administered Gerocognitive Examination). Secondly, a general practitioner, blinded to Test Your Memory and Self-Administered Gerocognitive Examination scores, performed a structured evaluation using the Mini-Mental State Examination. Subsequently, patients suspected of cognitive impairment (on either the cognitive tests or general practitioner evaluation) and a random sample of 30% of patients not suspected of cognitive impairment were evaluated at a memory clinic. Diagnostic accuracy and area under the curve were determined for the Test Your Memory, Self-Administered Gerocognitive Examination and general practitioner evaluation compared with a memory clinic evaluation to detect cognitive impairment (mild cognitive impairment or dementia).
  
  
  
  A total of 44 participants were diagnosed with cognitive impairment. The Test Your Memory and Self-Administered Gerocognitive Examination questionnaires had negative predictive values of 81 and 85%, respectively. Positive predictive values were 39 and 40%, respectively. The general practitioner evaluation had a negative predictive value of 83% and positive predictive value of 64%. The area under the curve was ~0.70 for all tests.
  
  
  
  Both the tests evaluated in the present study can easily be used in case-finding strategies for cognitive impairment in patients with Type 2 diabetes in primary care. The Self-Administered Gerocognitive Examination had the best diagnostic accuracy and therefore we would have a slight preference for this test. Applying the Self-Administered Gerocognitive Examination would considerably reduce the number of patients in whom the general practitioner needs to evaluate cognitive functioning to tailor diabetes treatment.
authors.affiliation: Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands.
authors.forename: P S
authors.initials: PS
authors.lastname: Koekkoek
authors.affiliation: Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Janssen
authors.affiliation: Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Kooistra
authors.affiliation: Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: J M
authors.initials: JM
authors.lastname: Biesbroek
authors.affiliation: Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: O
authors.initials: O
authors.lastname: Groeneveld
authors.affiliation: Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.|Experimental Psychology, Helmholtz Instituut, Utrecht University, Utrecht, The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: van den Berg
authors.affiliation: Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: L J
authors.initials: LJ
authors.lastname: Kappelle
authors.affiliation: Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: G J
authors.initials: GJ
authors.lastname: Biessels
authors.affiliation: Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands.
authors.forename: G E H M
authors.initials: GE
authors.lastname: Rutten
mesh_terms: D000368:Aged; D060825:Cognitive Dysfunction / Q000175:diagnosis*; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology*; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D008569:Memory Disorders / Q000175:diagnosis; D009483:Neuropsychological Tests; D011446:Prospective Studies; D012372:ROC Curve; D012648:Self Care; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires