A Review of Screening Tools for Early Detection of Dementia

The early detection of dementia may have significant benefits, allowing individuals in the early stages of cognitive decline to make decisions for the future, or to begin therapies to manage memory decline. Because of this, there is a need for dementia screening tools that can be used by clinicians who work with older adults but who may not have training in neuropsychology or other specialties. A recent review article in the Canadian Journal on Aging/Revue canadienne du vieillissement presents a summary of the existing research on dementia screening tools.

A screening tool is not used to administer a diagnosis of a disease, but to indicate whether further clinical evaluation for a specific disease is warranted. Because of the inevitably high rate of false positives in any screening tool (which is, by design, brief and simple to administer) screening tools should only be used for individuals at risk for the targeted disease. Screening tools should be assessed for both sensitivity (correctly identifying individuals with a disease) and specificity (ruling out individuals who do not have a disease). The authors of the review looked at all published research findings on English-language dementia screening tools, published since 1995, that could be administered by clinicians without specialized neurological training. To be included in their review, the studies also had to include a follow-up of at least 6 months in order for some indication of the predictive ability of the screening tools.

The authors identified 12 studies that met their criteria, which covered 15 different screening tools. They examined the findings of the sensitivity and specificity of the screening tools, as well as whether they included several cognitive domains (such as memory, attention, language, and spatial abilities) and the ease and brevity of administration. Because this was based on 12 studies, and the various screening tools were not assessed using the same study design (for example, some studies had longer follow-up periods than others), caution is warranted in comparing screening tools based on current research findings.

The strongest screening tool based on evidence on specificity, sensitivity, and usefulness was Addenbrooke’s Cognitive Examination (ACE), but the authors note that the modified version (ACE-R) is more commonly used in clinical settings and was not assessed in any of the 12 studies. Because there is not yet high-quality longitudinal data on the ACE-R, further study is warranted.  Other screening tools recommended by the authors were the Cognitive Capacity Screening Examination, Chinese Abbreviated Mild Cognitive Impairment Test, and the memory portion of the Cambridge Cognitive Examination. The widely used Montreal Cognitive Assessment was also considered a good measure, as it showed sensitivity for mild cognitive impairment.

Source:

Lischka AR, Mendelsohn M, Overend T, and Forbes D. A systematic review of screening tools for predicting the development of dementia. Canadian Journal on Aging/La Revue canadienne du vieillissement; (2012). 31(3): 295-311.

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