Risk Factors of Cognitive Impairment and Brief Cognitive Tests to Predict Cognitive Performance Determined by a Formal Neuropsychological Evaluation of Primary Health Care Patients

Muhammad Amin Shaik; Qun Lin Chan; Jing Xu; Xin Xu; Richard Jor Yeong Hui; Steven Shih Tsze Chong; Christopher Li-Hsian Chen; YanHong Dong

doi:10.1016/j.jamda.2015.12.007

Risk Factors of Cognitive Impairment and Brief Cognitive Tests to Predict Cognitive Performance Determined by a Formal Neuropsychological Evaluation of Primary Health Care Patients

J Am Med Dir Assoc. 2016 Apr 1;17(4):343-7. doi: 10.1016/j.jamda.2015.12.007. Epub 2016 Jan 16.

Authors

Muhammad Amin Shaik¹, Qun Lin Chan¹, Jing Xu¹, Xin Xu¹, Richard Jor Yeong Hui², Steven Shih Tsze Chong², Christopher Li-Hsian Chen¹, YanHong Dong³

Affiliations

¹ Department of Pharmacology, National University of Singapore, Singapore; Memory Aging and Cognition Centre, National University Health System, Singapore.
² NHG Polyclinics, National Healthcare Group, Singapore.
³ Department of Pharmacology, National University of Singapore, Singapore; Memory Aging and Cognition Centre, National University Health System, Singapore; Centre for Healthy Brain Ageing (CHEBA) and Dementia Collaborative Research Centre-Assessment and Better Care, School of Psychiatry, UNSW Medicine, The University of New South Wales, Australia. Electronic address: yanhong_dong@nuhs.edu.sg.

PMID: 26785695
DOI: 10.1016/j.jamda.2015.12.007

Abstract

Background: Case finding for cognitive impairment (CI) is recommended for all persons older than 70 years.

Objective: The present study identified additional risk factors of CI so as to operationalize a composite total risk score (TRS) for case finding. We then examined the additive effect of the TRS and brief cognitive tests to improve the diagnosis of CI.

Methods: The study was conducted in 2 primary health care centers in Singapore. A total of 1082 individuals (≥60 years old) were assessed for sociodemographic risk factors and their informants were administered the AD8; 309 individuals who agreed for further cognitive assessments completed the Mini-mental state examination (MMSE) and Montreal Cognitive Assessment (MoCA), and a neuropsychological battery at a research center. Primary health care medical records were accessed for data on vascular risk factors.

Results: Of the 309 individuals who underwent neuropsychological evaluation, 4 were excluded due to missing medical data; 167 (54.8%) individuals had CI and 138 (45.2%) had No Cognitive Impairment (NCI). The β coefficients were standardized to calculate risk scores. CI was significantly predicted by age >70 years (odds ratio [OR] 5.99; score = 3), diabetes (OR 3.36; score = 2), stroke (OR 2.70; score = 1), female gender (OR 2.02; score = 1) and individual cognitive complaints (SCC) (OR 1.95; score = 1). The TRS had an optimal cutoff of ≥3 and explained considerable variance in global cognitive composite Z-scores (R(2) = 0.41, P < .001). The MoCA explained substantial variance compared with the MMSE and AD8 (R(2) changes of 0.474, 0.422, and 0.157, P < .001, respectively).

Conclusion: The TRS is a reasonable measure to predict individuals at risk of CI. The addition of the MoCA, in persons with positive TRS scores, is a useful approach to improve the diagnosis of CI for at-risk patients attending primary health care.

Keywords: Case finding; cognitive impairment; primary care; risk factors.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Cognitive Dysfunction / diagnosis*
Female
Humans
Male
Neuropsychological Tests*
Primary Health Care*
Risk Factors
Singapore