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Suggested instruments for General Practitioners in countries with low schooling to screen for cognitive impairment in the elderly

Published online by Cambridge University Press:  21 March 2014

Alessandro Ferrari Jacinto ,
Sonia Maria Dozzi Brucki ,
Claudia Sellitto Porto ,
Milton de Arruda Martins ,
Vanessa de Albuquerque Citero  and
Ricardo Nitrini
Alessandro Ferrari Jacinto*
Affiliation:
Department of Psychiatry, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Brazil
Sonia Maria Dozzi Brucki
Affiliation:
Department of Neurology, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
Claudia Sellitto Porto
Affiliation:
Department of Neurology, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
Milton de Arruda Martins
Affiliation:
Department of Internal Medicine, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
Vanessa de Albuquerque Citero
Affiliation:
Department of Psychiatry, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Brazil
Ricardo Nitrini
Affiliation:
Department of Neurology, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
*
Correspondence should be addressed to: Alessandro Ferrari Jacinto, Department of Psychiatry, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Rua São Carlos do Pinhal, 508/121, São Paulo 01333-000, Brazil. Phone: +5511982622970; Fax: +551138072970. Email: alessandrojacinto@uol.com.br.
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Abstract

Background:

General Practitioners (GPs) from underdeveloped countries apply cognitive impairment (CI) assessment tools translated and adapted to cultural setting from other idioms, mainly English. As schooling in elderly from underdeveloped countries tends to be relatively heterogeneous, it is necessary to establish normative and cut-off scores for these CI instruments that are based on studies conducted locally. Some CI screening instruments frequently used by Brazilian specialists in dementia were analyzed to determine which could be most useful to GPs in their working sets.

Method:

Two hundred forty-eight patients aged 65 years or older that had been assisted by GPs in a tertiary hospital in Brazil were evaluated. Based on the MMSE and/or Short-IQCODE scores, 52 probable cases were identified on the basis of clinical data, performances on the neuropsychological tests and questionnaires (Functional Assessment Questionnaire/FAQ, Category Verbal Fluency/CVF, Clock Drawing Test/CDT) and blood tests and brain CT.

Results:

The combination of a functional questionnaire with a cognitive instrument had higher sensitivity and specificity than using the instruments alone. A FAQ cut-off of 3 in conjunction with a CDT cut-off of 6 proved optimal (93% sensitivity and 92.5% specificity). A higher specificity (93.5%) was attained using a combination of the FAQ (cut-off of 3) with the CVF (cut-off of 10).

Conclusions:

For low schooling elderly, the combination of the FAQ and CVF represented a very simple method of increasing the chances of correct screening. For those with higher schooling, the combination of the FAQ and CDT was more suitable.

Keywords

cognitive impairmentscreeningcognitive testingdeveloping countryaging
Type
Research Article
Information
International Psychogeriatrics , Volume 26 , Issue 7 , July 2014 , pp. 1121 - 1125
Copyright
Copyright © International Psychogeriatric Association 2014 

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