Suspected Dementia in Young Adults: Cognitive Screening Tools for Use in Primary Care

Author:

Mukaetova-Ladinska Elizabeta B.12,Abdullah Shahbaz13,Critchfield Mathew1,Maltby John2

Affiliation:

1. The Evington Center, Leicesterhire Partership NHS Trust, Leicester, UK

2. Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK

3. Leicestershire, Northamptonshire & Rutland (LNR) Foundation School, Leicester, UK

Abstract

Background: Memory complaints are frequent among young adults presenting in general practice. Many of them will have reversable, functional cognitive impairment that can easily be mistaken for dementia. Its accurate and timely identification is warranted to prevent further escalation to overt dementia syndrome. Objective: To evaluate the recommended primary care screening cognitive tools for dementia for use in younger people. Methods: 2.5 years clinical data were collected during the course of ongoing patient care for all assessed face-to-face patients in a secondary care memory service for younger adults. Cognitive screening and assessment tests used in primary [General Practice Assessment of Cognition (GPCOG)] and secondary [Addenbrooke’s Cognitive Examination-III (ACE-III), Rowland Universal Dementia Assessment Scale (RUDAS), Salzburg Dementia Test Prediction (SDTP)] care were analyzed for their accuracy to identify dementia and memory complaints. Area under the curve in receiver operating characteristic curves was used to measure predictive value of tests for a clinical diagnosis of dementia. Results: 348 young adults were assessed for cognitive impairment. Following comprehensive Memory Clinic assessments, 241 (69.25%) were diagnosed with memory complaints in the absence of relevant neuropathology and 107 with dementia. GPCOG, especially the informant part, and RUDAS had low accuracy to identify dementia (AUC = 0.465 and AUC = 0.698, respectively). In contrast, ACE-III and SDTP demonstrated the highest accuracy (AUC = 0.799 and AUC = 0.809/0.817, respectively). Conclusion: Dementia screening in younger people will benefit from SDTP incorporated as part of the screening cognitive toolset. The national guidance on dementia screening tools, diagnostic pathways, and management should also refer to younger adults.

Publisher

IOS Press

Subject

Psychiatry and Mental health,Geriatrics and Gerontology,Clinical Psychology,General Medicine,General Neuroscience

Reference31 articles.

1. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission;Livingston;Lancet,2020

2. National Institute for Health and Care Excellence (UK) (2018) Dementia: Assessment, management and support for people living with dementia and their carers N 97. NICE, London.

3. The GPCOG: A new screening test for dementia designed for general practice;Brodaty;J Am Geriatr Soc,2002

4. Advancing research diagnostic criteria for Alzheimer’s disease: The IWG-2 criteria;Dubois;Lancet Neurol,2014

5. 2014 Standards for Educational and Psychological Testing: Implications for ethnic minority youth.

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