title: The Combined Utility of a Brief Functional Measure and Performance-Based Screening Test for Case Finding of Cognitive Impairment in Primary Healthcare.
abstract: BACKGROUND
  Use of a total risk score (TRS) based on vascular and sociodemographic risk factors has been recommended to identify patients at risk of cognitive impairment. Moreover, combining screening tests has been reported to improve positive predictive values (PPV) for case finding of cognitive impairment.
  
  
  OBJECTIVE
  We investigated the utility of the conjunctive combination of the informant-based AD8 and the performance-based National Institute of Neurological Disorders and Stroke-Canadian Stroke Network (NINDS-CSN) 5-minute protocol for the detection of cognitive impairment, defined by a clinical dementia rating (CDR) score ≥0.5, in patients at risk of cognitive impairment (TRS ≥3).
  
  
  METHODS
  Participants were recruited from 2 primary healthcare centers in Singapore and received the AD8, Montreal Cognitive Assessment, Mini-Mental State Examination, CDR, and a formal neuropsychological test battery. The scores for NINDS-CSN 5-minute protocol were extracted from the Montreal Cognitive Assessment items. Area under the receiver operating characteristics curve analyses were conducted to determine the discriminant indices of the screening instruments, the conjunctive combination (ie, screened positive on both tests), and the compensatory combination (ie, screened positive in either of or both tests).
  
  
  RESULTS
  A total of 309 participants were recruited of whom 78.7% (n = 243) had CDR = 0 and 21.3% (n = 66) had CDR ≥0.5. The conjunctive combination of AD8 and NINDS-CSN 5-minute protocol achieved excellent PPV and acceptable sensitivity (PPV 91.7%, sensitivity 73.3%).
  
  
  CONCLUSIONS
  The conjunctive combination of the AD8 and NINDS-CSN 5-minute protocol is brief and accurate, and hence, suitable for case finding of cognitive impairment (CDR ≥0.5) in patients screened positive on the TRS in primary healthcare centers.
authors: Department of Pharmacology, National University of Singapore, Singapore, Singapore; Memory Aging and Cognition Center, National University Health System, Singapore, Singapore.
authors: Qun Lin
authors: QL
authors: Chan
authors: Department of Pharmacology, National University of Singapore, Singapore, Singapore; Memory Aging and Cognition Center, National University Health System, Singapore, Singapore.
authors: Muhammad Amin
authors: MA
authors: Shaik
authors: Department of Pharmacology, National University of Singapore, Singapore, Singapore; Memory Aging and Cognition Center, National University Health System, Singapore, Singapore.
authors: Jing
authors: J
authors: Xu
authors: Department of Pharmacology, National University of Singapore, Singapore, Singapore; Memory Aging and Cognition Center, National University Health System, Singapore, Singapore.
authors: Xin
authors: X
authors: Xu
authors: Department of Pharmacology, National University of Singapore, Singapore, Singapore; Memory Aging and Cognition Center, National University Health System, Singapore, Singapore.
authors: Christopher Li-Hsian
authors: CL
authors: Chen
authors: Department of Pharmacology, National University of Singapore, Singapore, Singapore; Memory Aging and Cognition Center, National University Health System, Singapore, Singapore; Center for Healthy Brain Aging and Dementia Collaborative Research Center, Assessment and Better Care, School of Psychiatry, University of New South Wales Medicine, The University of New South Wales, Kensington, Australia. Electronic address: yanhong_dong@nuhs.edu.sg.
authors: YanHong
authors: Y
authors: Dong
mesh_terms: D000368:Aged; D060825:Cognitive Dysfunction / Q000175:diagnosis*; D004185:Disability Evaluation; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D011320:Primary Health Care; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012846:Singapore; D011795:Surveys and Questionnaires
keywords: Case finding; cognitive screening; dementia; primary care