Detecting cognitive impairment in primary care: Performance assessment of three screening instruments

A new study published in the June issue of Journal of Alzheimer's Disease demonstrates the accuracy and validity of a new mathematics-based memory assessment developed by Medical Care Corporation to detect early signs of memory impairment due to Alzheimer's disease and other related disorders.

The assessment, called the MCI Screen, outperformed two of the most widely used pen-and-paper tests and its accuracy helps justify the importance of regular memory assessments of people over 65 by primary care physicians, according to the study's authors.

The 254-patient study, titled "Detecting Cognitive Impairment in Primary Care: Performance Assessment of Three Screening Instruments," was conducted by Douglas Trenkle, D.O., a primary care physician at Maine Coast Memorial Hospital in Ellsworth, Maine, as a part of the Hancock County Aging Project. It compared the MCI Screen to the two most widely used pen-and-paper assessments: the Mini-Mental Status Exam (MMSE) and the Clock Drawing Test (CDT) in patients over 65 without previous diagnosis of memory disorders. Those found to be impaired with any of the three assessments received a standard diagnostic workup including blood tests and brain imaging.

The MCI Screen, a simple, computer-based memory assessment, was 96 percent accurate in detecting impaired patients, while the MMSE was 72 percent accurate and the CDT 57 percent. The MCI Screen detected memory disorders from a variety of conditions ranging from Alzheimer's disease (43 percent) to cerebrovascular disease (36 percent) to depression (3 percent). Of the 254 patients assessed, 20 percent were found to have underlying medical conditions. However, two-thirds had no subjective complaints of impairment and would not have received medical attention if they had not been screened for memory loss.

"This study shows that there is a test that can accurately and efficiently detect memory disorders at early stages when treatment is most effective," Dr. Trenkle said. "Too often we have relied on the two widely-used memory screens, MMSE and CDT, which the study shows are not valid for early detection. The accuracy of the MCI Screen demonstrates that primary care physicians, who are the first point of contact in our heath care system, can play significant roles in assessing and treating several age-related diseases in a population that is rapidly aging."

William R. Shankle, M.D., of the Department of Cognitive Sciences at UC Irvine, and Stanley P. Azen, Ph.D., of the Department of Preventative Medicine, Keck School of Medicine at the University of Southern California, also co-authored the study.

Many conditions can cause memory impairment. These include Alzheimer's disease, stroke, heart disease, diabetes, and other disorders. Early detection and appropriate intervention of any of these disorders improves treatment outcome significantly and delays or prevents debilitating conditions. In a typical primary care practice, patients with memory impairment are either not getting enough attention or are being assessed by less sensitive tools. This inevitably leads to late stage diagnoses where treatment is not as effective. With the rapidly aging population and high prevalence of such disorders in the baby boomer generation, early and accurate detection of memory impairing disorders benefits the patients, the caregivers and our health care system.

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