Abstract
Background: Many health systems are interested in increasing the number of uncomplicated and typical dementia diagnoses that are made in primary care, but the comparative accuracy of tests is unknown.
Objective: Calculate diagnostic accuracy of brief cognitive tests in primary care
Design: We did a diagnostic test accuracy study in general practice, in people over 70 years who had consulted their GP with cognitive symptoms but had no prior diagnosis of dementia. The reference standard was specialist assessment, adjudicated for difficult cases, according to ICD-10. We assessed 16 index tests at a research clinic, and additionally analysed referring GPs clinical judgement.
Results: 240 participants had a median age of 80 years, of whom 126 were men and 132 had dementia. Sensitivity of individual tests at the recommended thresholds ranged from 56% for GP judgement (specificity 89%) to 100% for MoCA (specificity 16%). Specificity of individual tests ranged from 4% for Sniffin’ sticks (sensitivity 100%) to 91% for TUG (sensitivity 23%). The 95% centile of test duration in people with dementia ranged from 3 minutes for 6CIT and TAC, to 16 minutes for MoCA. Combining tests with GP judgement increased test specificity and decreased sensitivity: e.g., MoCA with GP Judgement had specificity 87% and sensitivity 55%.
Conclusions Using GP judgement to inform selection of tests was an efficient strategy. Using IQCODE in people who GPs judge as having dementia and 6CIT in people who GPs judge as having no dementia, would be a time-efficient and accurate diagnostic assessment.
The original protocol for the study is available at https://bmcfampract.biomedcentral.com/articles/10.1186/s12875-016-0475-2
Objective: Calculate diagnostic accuracy of brief cognitive tests in primary care
Design: We did a diagnostic test accuracy study in general practice, in people over 70 years who had consulted their GP with cognitive symptoms but had no prior diagnosis of dementia. The reference standard was specialist assessment, adjudicated for difficult cases, according to ICD-10. We assessed 16 index tests at a research clinic, and additionally analysed referring GPs clinical judgement.
Results: 240 participants had a median age of 80 years, of whom 126 were men and 132 had dementia. Sensitivity of individual tests at the recommended thresholds ranged from 56% for GP judgement (specificity 89%) to 100% for MoCA (specificity 16%). Specificity of individual tests ranged from 4% for Sniffin’ sticks (sensitivity 100%) to 91% for TUG (sensitivity 23%). The 95% centile of test duration in people with dementia ranged from 3 minutes for 6CIT and TAC, to 16 minutes for MoCA. Combining tests with GP judgement increased test specificity and decreased sensitivity: e.g., MoCA with GP Judgement had specificity 87% and sensitivity 55%.
Conclusions Using GP judgement to inform selection of tests was an efficient strategy. Using IQCODE in people who GPs judge as having dementia and 6CIT in people who GPs judge as having no dementia, would be a time-efficient and accurate diagnostic assessment.
The original protocol for the study is available at https://bmcfampract.biomedcentral.com/articles/10.1186/s12875-016-0475-2
| Original language | English |
|---|---|
| Pages (from-to) | 1189-1200 |
| Number of pages | 12 |
| Journal | Journal of Alzheimer's Disease |
| Volume | 95 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - 26 Sept 2023 |
Bibliographical note
Funding Information:The Wellcome Trust (Fellowship 108804/Z/15/z £321,248), Avon Primary Care Research Collaboration (£19,705), The Claire Wand fund (£5040), and the National Institute for Health Research School for Primary Care Research (£9,971). The Western Clinical Research Networks approved an application for service support costs for practices to provide for the expense of room hire in GP clinics and GPs referring people to the study. YBS is partially supported by the NIHR Applied Research Collaboration West (NIHR ARC West). The views expressed in this article are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. This research was funded in whole, or in part, by the Wellcome Trust [108804/Z/15/15/z]. For the purpose of Open Access, the author has applied a CC BY public copyright license to any Author Accepted Manuscript version arising from this submission.
Publisher Copyright:
© 2023 - IOS Press. All rights reserved.
Keywords
- Humans
- Aged, 80 and over
- Dementia/diagnosis
- General Practitioners
- Cognition
- Primary Health Care
- Diagnostic Tests, Routine
- Sensitivity and Specificity
- Cognitive Dysfunction/diagnosis