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A Quick Test of Cognitive Speed (AQT): Usefulness in dementia evaluations in primary care
Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Primary Health Care in Central County.
Karolinska Institute, Sweden .
Linköping University, Department of Clinical and Experimental Medicine, Geriatric. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine in Linköping.ORCID iD: 0000-0003-4166-7269
Linköping University, Department of Clinical and Experimental Medicine, Geriatric. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine in Linköping.
2013 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 31, no 1, p. 13-19Article in journal (Refereed) Published
Abstract [en]

Objective. To validate A Quick Test of Cognitive Speed (AQT) as an instrument in diagnostic dementia evaluations against final clinical diagnosis and compare AQT with the Mini-Mental State Examination (MMSE) and Clock Drawing Test (CDT) in primary care. Design. Primary health care cohort survey. Setting. Four primary health care centres and a geriatric memory clinic in Sweden. Patients. 81 patients (age 65 and above) were included: 52 with cognitive symptoms and 29 presumed cognitively healthy. None of the patients had a previous documented dementia diagnosis. All patients performed MMSE, CDT, and AQT at the primary health care clinic and were referred for extensive neuropsychological testing at a memory clinic. AQT was validated against final clinical diagnosis determined by a geriatric specialist and a neuropsychologist. Main outcome measures. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratios, correlation data, and receiver operating characteristic (ROC). Results. For MMSE, sensitivity and specificity was 0.587 and 0.909; CDT 0.261 and 0.879; and AQT 0.783 and 0.667, respectively. For the combination of MMSE and CDT, sensitivity and specificity was 0.696 and 0.788, for MMSE and AQT 0.913 and 0.636. The ROC curve for AQT showed an area under curve (AUC) of 0.773. Conclusion. Our results suggest AQT is a usable test for dementia assessments in primary care. Sensitivity for AQT is superior to CDT, equivalent to MMSE, and comparable to the combination MMSE and CDT. MMSE in combination with AQT improves sensitivity. Because AQT is user-friendly and quickly administered, it could be applicable for primary care settings.

Place, publisher, year, edition, pages
Informa Healthcare , 2013. Vol. 31, no 1, p. 13-19
Keywords [en]
Alzheimers disease, dementia, general practice, A Quick Test of Cognitive Speed (AQT), Clock Drawing Test (CDT), Mini-Mental Status Examination (MMSE), primary care, Sweden
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-89797DOI: 10.3109/02813432.2012.751699ISI: 000314653700005OAI: oai:DiVA.org:liu-89797DiVA, id: diva2:609796
Note

Funding Agencies|Swedish Brain Power||ALF Grants||County Council of Ostergotland||

Available from: 2013-03-07 Created: 2013-03-07 Last updated: 2019-09-20
In thesis
1. Dementia diagnostics in primary care: with a focus on cognitive testing
Open this publication in new window or tab >>Dementia diagnostics in primary care: with a focus on cognitive testing
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background

Age is the greatest risk factor for developing dementia and the total number of people aged 60 years and above is expected to more than double globally from 2013 to 2050 (1). Primary health care (PHC) is important for basic diagnostic evaluations. Objective test measurements have been shown to be more reliable than a patient's subjective memory complaints in dementia assessments (2). However, several studies indicate the low use of objective cognitive screening tools in dementia diagnostics in PHC (3). Some general practitioners (GPs) do not perceive today’s cognitive instruments as helpful in the diagnostic process and administration problems have been reported in PHC (4, 5).

The overall aim of this thesis was to investigate the accuracy of several cognitive tests used in dementia assessments in PHC, especially among older patients: A Quick Test of Cognitive Speed (AQT), Cognistat and Cognitive Assessment Battery (CAB). The normative values of the Mini Mental Status Examination (MMSE) in the oldest old was also studied.

Methods

The studies included in this thesis are from two different study populations.

  • Studies I, II and IV. Patients with and without cognitive symptoms were recruited from four primary health care centres in Sweden between 2007 and 2009.
  • Study III. The Elderly in Linköping Screening Assessment (ELSA 85) cohort-population examined people born in 1922 in the municipality of Linköping, Sweden.

Results

Study I. Results showed that AQT is a usable test for dementia diagnosis in PHC. Sensitivity for AQT is superior to the Clock Drawing Test (CDT), equivalent to MMSE and the combination MMSE and CDT. The AUC for AQT was 0.773, valued good enough.

Study II. Overall, the results for Cognistat in this study are superior to MMSE and CDT, also in combination. Cognistat is promising for improved dementia diagnosis in PHC with a quick and easily administered multi-domain test for dementia assessments.

Study III. This study presents valuable information about normative MMSE data for the oldest patients. Results, suggest using the 25th percentile in MMSE of 25 to 26 points, and indicate that MMSE 26 is as a reasonable cut-off for cognitive decline and further medical evaluation in older persons aged from 85 to 93 years.

Study IV. In summary, the additive value of the CAB test in dementia investigations in PHC is not obvious. In addition to questionable accuracy, the test is quite time consuming and normative values are scarce. By introducing the numerical sum (CABsum) the accuracy was increased.

Conclusion

In conclusion, objective cognitive tests are an important part of dementia diagnosis in PHC and there is a need for improved instruments and norm-values. From our results, several cognitive quick tests are usable in PHC - MMSE, AQT and Cognistat - but they have some disadvantages. MMSE 26 is a reasonable cut-off for cognitive decline in the oldest patients 85 to 93 years from a well-educated population with quite good socioeconomic. There is a great interest in finding short and better multi-domain instruments but the additive value of CAB in dementia investigations in PHC is questionable.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2019. p. 80
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1691
National Category
General Practice
Identifiers
urn:nbn:se:liu:diva-160371 (URN)10.3384/diss.diva-160371 (DOI)9789176850374 (ISBN)
Public defence
2019-10-18, Berzeliussalen, Hus 463, Campus US, Linköping, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2019-09-20 Created: 2019-09-20 Last updated: 2019-10-01Bibliographically approved

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Segernäs Kvitting, AnnaJohansson, MariaMarcusson, Jan

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