In Review Brief Screening Tests for Dementia

Objective: To compare brief dementia screening tests as candidates for routine use in pri-mary care practice. Method: We selected screening tests that met 2 criteria: 1) administration time of 10 min-utes or less in studies including individuals with, and without, dementia; and 2) perform-ance characteristics evaluated in at least 1 community or clinical sample of older adults. We compared tests for face validity, sensitivity, and specificity in a clearly defined subject sample; for vulnerability to sociodemographic biases unrelated to dementia; for direct com-parison with an accepted standard; for acceptability to patients and doctors; and for brevity and ease of administration, scoring, and interpretation by nonspecialists. Results: Thirteen instruments met our inclusion criteria. Very short tests (1 minute or less) proved unacceptable by several criteria. Standard instruments requiring more than 5 min-utes to complete, including the best-studied Mini-Mental State Examination (MMSE), were found to be too long for routine application. Several failed other performance tests or could not be adequately assessed. Short tests taking between 2 and 5 minutes that can be adminis-tered by nonspecialists with little or no training and are relatively unbiased by language and education level appear to be superior to both shorter and longer instruments. Conclusions: Three tests showed the most promise for broad application in primary care settings: the Mini-Cog, the Memory Impairment Screen, and the General Practitioner As-sessment of Cognition (GPCOG). Formal practice intervention trials are now needed to validate the utility of short screens with regard to implementation, effect on rates of diag-nosis and treatment of dementia patients, and outcomes for patients, families, and health care systems. (Can J Psychiatry 2002;47:723–733) See page 731 for funding support and page 732 for author affiliations