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TheMini-CogasaScreenforDementia:Validationina Population-BasedSample SooBorson,MD, JamesM.Scanlan,PhD, PeijunChen,MD,PhD, wzandMaryGanguli,MD,MPH zOBJECTIVES:TotesttheMini-Cog,abriefcognitive screeningtest,inanepidemiologicalstudyofdementiain olderAmericans. DESIGN:Apopulation-basedposthocexaminationofthe sensitivityandspeciÞcityoftheMini-Cogfordetecting dementiainanexistingdataset. SETTING:TheMonongahelaValleyinWesternPennsyl- vania.PARTICIPANTS: Arandomsampleof1,119olderadults enrolledintheMonongahelaValleyIndependentElders Survey(MoVIES). MEASUREMENTS:TheeffectivenessoftheMini-Cogin detectingindependentlydiagnoseddementiawascompared withthatoftheMini-MentalStateExamination(MMSE) andastandardizedneuropsychologicalbattery. RESULTS: TheMini-Cog,scoredbyanalgorithmas ÔÔpossiblyimpairedÕÕorÔÔprobablynormal,ÕÕandtheMMSE, atacutpointof25,hadsimilarsensitivity(76%vs79%) andspeciÞcity(89%vs88%)fordementia,comparable withthatachievedusingaconventionalneuropsychological battery(75%sensitivity,90%speciÞcity). CONCLUSION:Whenappliedposthoctoanexisting population,theMini-Cogwasaseffectiveindetecting dementiaaslongerscreeningandassessmentinstruments. Itsbrevityisadistinctadvantagewhenthegoalisto improveidentiÞcationofolderadultsinapopulation whomaybecognitivelyimpaired.Priorevidenceofgood performanceinamultiethniccommunity-basedsample furthersupportsitsvalidityintheethnolinguistically diversepopulationsoftheUnitedStatesinwhichwidely usedcognitivescreensoftenfail. JAmGeriatrSoc 51:1451Œ1454,2003. Keywords:MMSE;MoVIES;epidemiology;briefdemen- tiascreens Withtherecentavailabilityofusefultherapiesandstrong evidencethatdementiaisunrecognizedin40%to 75%ofpatientsinprimarycare, 1Ð6 thedevelopmentofrapid, easy-to-usedementia-detectionsystemshasbecomeaninter- nationalpriorityforimprovingcareofpatientswiththis prevalentneuropsychiatricdisorderoflatelife. 7Althoughmanyprimarycarephysiciansendorsescreening,practicing physiciansdonotcommonlyperformitandoftenconsiderit tobetootime-consuming 8,9 orunhelpful. 10Criticalproper- tiesofdementia-screeningtoolsproposedforbroadapplica- tioninprimarycarethereforeincluderapidadministration, simplescoring,goodbalancebetweendementiasensitivity andspeciÞcity,patientacceptance,andsuperioritytospon- taneousrecognitionofdementiabypatientsÕprimaryphysi- cians.Additionalimportantfe aturesincludeminimalbiasdue tofactorsextraneoustodementiasuchaseducationaland ethnolinguisticdifferences,screeningefÞcacycomparable withestablishedprocedures,andefÞciencyinepidemiological andclinicalapplications.Anumberofbriefcognitivescreens havebeendeveloped,andtheirknownperformancechar- acteristicshaverecentlybeenreviewed. 11Limitationsin publishedstudiesofmanyshortscreensaretheabsenceof dataabouttheirperformanceincomparisonwithwidely acceptedprocedures(suchastheMini-MentalStateExami- nation(MMSE))andinepidemiologicalsamples,inwhich therelativelylowratesofdementiaencounteredinthe generalolderadultpopulationchallengetesteffectiveness. Therefore,prospectivetestingofnewdementiascreening instrumentsinrepresentativesamplesisthemostdesirable approachtoestablishingtheirvalidityandutilitybutis prohibitivelylabor-intensive duringtheearlystagesoftest development.Theuseofexistingdatasetsforthispurpose allowsinitialevaluationofaproposedprocedurebeforefull- scaleprospectivetestingisfeasibleorjustiÞed. SupportedbygrantsfromtheNationalInstituteonAging(AG-05136,Drs. BorsonandScanlan;AG-7562,Drs.GanguliandChen).Abstractpresented inpartattheannualmeetingoftheAmericanAssociationforGeriatric Psychiatry,February2001. AddresscorrespondenceSooBorson,MD,UniversityofWashingtonSchool ofMedicine,1959NEPaciÞcStreet,Box356560,Seattle,WA98195.E-mail: soob@u.washington.edu Fromthe DepartmentofPsychiatryandBehavioralSciencesandthe AlzheimerÕsDiseaseResearchCenter,UniversityofWashington,Seattle, Washington; wDepartmentofPsychiatry,UniversityofMichigan,AnnArbor, Michigan;and zDepartmentofPsychiatry,UniversityofPittsburgh, Pittsburgh,Pennsylvania. JAGS51:1451Ð1454,2003 r2003bytheAmericanGeriatricsSociety 0002-8614/03/$15.00
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