International Psychogeriatrics

Review Article

Screening for dementia in primary care: a review of the use, efficacy and quality of measures

A. Milnea1 c1, A. Culverwella2, R. Gussa3, J. Tuppena4 and R. Wheltona1

a1 Tizard Centre, University of Kent, Canterbury, U.K.

a2 Kent and Medway NHS and Social Care Partnership Trust, St Martin's Hospital, Canterbury, U.K.

a3 Kent and Medway NHS and Social Care Partnership Trust, Medway Maritime Hospital, Gillingham, Kent, U.K.

a4 Kent and Medway NHS and Social Care Partnership Trust, The Beacon, Ramsgate, Kent, U.K.

ABSTRACT

Background: Despite evidence that early identification of dementia is of growing policy and practice significance in the U.K., limited work has been done on evaluating screening measures for use in primary care. The aim of this paper is to offer a clinically informed synthesis of research and practice-based evidence on the utility, efficacy and quality of dementia screening measures.

Method: The study has three elements: a review of research literature, a small-scale survey of measures employed in three primary care trusts, and a systematic clinical evaluation of the most commonly used screening instruments. The study integrates data from research and clinical sources.

Results: The General Practitioner Assessment of Cognition (GPCOG), the Memory Impairment Screen (MIS), and the Mini-Cognitive Assessment Instrument (Mini-Cog) were found to be brief, easy to administer, clinically acceptable, effective, and minimally affected by education, gender, and ethnicity. All three have psychometric properties similar to the Mini-mental State Examination (MMSE).

Conclusions: Although the MMSE is widely used in the U.K., this project identifies the GPCOG, MIS and Mini-Cog as clinically and psychometrically robust and more appropriate for routine use in primary care. A coherent review of evidence coupled with an indepth evaluation of screening instruments has the potential to enhance ability and commitment to early intervention in primary care and, as part of a wider educational strategy, improve the quality and consistency of dementia screening.

(Received September 20 2007)

(Revised November 21 2007)

(Revised March 05 2008)

(Accepted March 05 2008)

(Online publication June 05 2008)

Correspondence:

c1 Correspondence should be addressed to: Dr Alisoun Milne, Tizard Centre, School of Social Policy, Sociology and Social Research, Beverley Farm, University of Kent, Canterbury, Kent, CT2 7LZ, U.K. Phone: +44 (0)1227-824047. Email: a.j.milne@kent.ac.uk.