An evaluation of dementia screening in the primary care setting

Purpose: To evaluate current screening methods for dementia to determine the most accurate and efficient tools for use in primary care. Data sources: Search included the following: Medline, CINAHL, BIOSIS, PsycINFO, ISI Web of Science, and Health & Psychosocial Instruments (1840-2005). The following search terms were used: screen, screening, tools, Mini Mental, MMSE, clock drawing, subjective memory, assessment, diagnosis, primary care, outpatient, community based, ambulatory care, dementia, cognitive impairment, and memory impairment. There was no limit to publication year. Articles excluded were those not published in English and those which used screening tools as part of diagnostic evaluation. The search revealed 581 relevant articles, which were narrowed to 20. Conclusions: The Mini Mental State Examination (MMSE) has high sensitivity and specificity in outpatients older than 65 years when age- and education-specific cutoffs are used. The clock drawing test has lower sensitivity and specificity when used alone; however, in combination with the MMSE, its sensitivity is higher than that of the MMSE while specificity is slightly lower. Subjective memory complaints contribute diagnostic information; however, objective memory performance is a stronger predictor of future dementia. All measures are subject to influence by age, education, and other physical factors. The body of evidence regarding dementia screening methods has increased in recent years. The studies have been well conducted, of large sample size, in various geographic locations and populations, and by numerous investigators. Implications for practice: Dementing illnesses will become a common presentation in primary care. Currently, routine screening is not conducted although acceptable instruments, such as the MMSE, are available. Additional research on routine screening in primary care to bolster the current evidence, use of nurses as evaluators of cognition, and utilization of specialists is needed.