title: Pilot Evaluation of a Dementia Case Finding Clinical Service Using the Informant AD8 for At-Risk Older Adults in Primary Health Care: A Brief Report.
abstract: An AD8 cut-off score of ≥4 has been reported to successfully detect 90% of dementia cases in elderly patients aged 75 years and above.
  
  
  
  We investigated the benefits of a pilot clinical service conducted in primary care that used the AD8 to identify patients with dementia in an at-risk population.
  
  
  
  Patients ≥75 years of age were recruited from a primary health care center in Singapore. Trained nurses administered the AD8 to informants of eligible patients. Patients screened positive (AD8 score ≥4) were referred to specialist memory clinics by primary health care physicians for further evaluation.
  
  
  
  Of the 551 eligible patients in the primary health care center, 168 (30.5%) consented and the AD8 was administered to their informants. Among the recruited patients, 23 (13.7%) were screened positive and 7 (30.4%) of them accepted referrals to specialist memory clinics. The clinical diagnoses for these patients were as follows: no cognitive impairment (NCI) (n = 1), cognitive impairment no dementia (CIND) (n = 5), and dementia (n = 1). Most of the (98.8%) nurses found AD8 user-friendly and could track functional decline. Eighteen of the 23 (78.3%) primary health care physicians who referred patients to specialist memory clinics considered the AD8 useful for facilitating referrals. The remaining physicians (21.7%) preferred performance-based tests.
  
  
  
  The AD8 is easily administered by nurses and useful to a majority of primary health care physicians to generate referrals. However, physician preference for performance-based tests and a lower prevalence of dementia in the at-risk population may indicate the need to consider a "2-pronged assessment approach" that combines both performance-based and informant-based brief tests to reduce false positive rates and better detect dementia.
authors.affiliation: Department of Pharmacology, National University of Singapore, Singapore; Memory Aging and Cognition Centre, National University Health System, Singapore.
authors.forename: Muhammad Amin
authors.initials: MA
authors.lastname: Shaik
authors.affiliation: Department of Pharmacology, National University of Singapore, Singapore; Memory Aging and Cognition Centre, National University Health System, Singapore.
authors.forename: Chia Hui
authors.initials: CH
authors.lastname: Khoo
authors.affiliation: Singhealth Polyclinics, Singapore.
authors.forename: Anandan Gerard
authors.initials: AG
authors.lastname: Thiagarajah
authors.affiliation: Singhealth Polyclinics, Singapore.
authors.forename: Ngiap Chuan
authors.initials: NC
authors.lastname: Tan
authors.affiliation: Department of Pharmacology, National University of Singapore, Singapore; Memory Aging and Cognition Centre, National University Health System, Singapore.
authors.forename: Christopher
authors.initials: C
authors.lastname: Li-Hsian Chen
authors.affiliation: Department of Pharmacology, National University of Singapore, Singapore; Memory Aging and Cognition Centre, National University Health System, Singapore.
authors.forename: Jing
authors.initials: J
authors.lastname: Xu
authors.affiliation: Department of Pharmacology, National University of Singapore, Singapore; Memory Aging and Cognition Centre, National University Health System, Singapore; Centre for Healthy Brain Ageing (CHeBA) and Dementia Collaborative Research Centre-Assessment and Better Care, School of Psychiatry, UNSW Medicine, The University of New South Wales, Kensington, New South Wales, Australia. Electronic address: yanhong_dong@nuhs.edu.sg.
authors.forename: YanHong
authors.initials: Y
authors.lastname: Dong
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000175:diagnosis*; D019937:Diagnostic Techniques and Procedures / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008297:Male; D058007:Physicians, Primary Care; D010865:Pilot Projects; D012846:Singapore; D011795:Surveys and Questionnaires
keywords: Case finding; cognitive screening; dementia; primary care