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Screening Older Latinos for Dementia in the Primary Care Setting

Published online by Cambridge University Press:  14 August 2014

Ellen Grober ,
Amy R. Ehrlich ,
Yaritza Troche ,
Steven Hahn  and
Richard B. Lipton
Ellen Grober*
Affiliation:
Department of Neurology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
Amy R. Ehrlich
Affiliation:
Division of Geriatrics of the Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
Yaritza Troche
Affiliation:
Department of Neurology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
Steven Hahn
Affiliation:
Department of Medicine, Albert Einstein College of Medicine and Jacobi Medical Center, Bronx, New York
Richard B. Lipton
Affiliation:
Department of Neurology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York Department of Epidemiology and Population Health, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
*
Correspondence and reprint requests to: Ellen Grober, Kennedy Center, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, New York 10461. E-mail: egrober@montefiore.org
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Abstract

The purpose was to compare the Spanish language picture version of the Free and Cued Selective Reminding Test with Immediate Recall (pFCSRT+IR) and the Mini Mental State Exam (MMSE) in identifying very mild dementia among Spanish speaking Latino patients. The tests and an independent diagnostic assessment were administered to 112 Latino patients free of medically diagnosed dementia from an urban primary care clinic. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) were used to examine differences in the operating characteristics of the pFCSRT+IR and the MMSE. Cut scores were manipulated to equate sensitivities (specificities) at clinically relevant values to compare differences in specificities (sensitivities) using the Pearson Chi Square test. Youden’s index was used to select the optimal cut scores. Twenty-four of the 112 primary care patients (21%) received a research dementia diagnosis, indicating a substantial burden of unrecognized dementia. MMSE scores but not free recall scores were associated with years of education in patients free of dementia. AUC was significantly higher for free recall than for MMSE. Free recall performed significantly better than the MMSE in sensitivity and in specificity. Using optimal cut scores, patients with impaired free recall were 10 times more likely to have dementia than patients with intact recall, and patients with impaired MMSE scores were 4.5 times more likely to have dementia than patients with intact scores. These results suggest that the Spanish language pFCSRT+IR may be an effective tool for dementia screening in educationally diverse Latino primary care populations. (JINS, 2014, 20, 1–8)

Keywords

MemoryDementiaPrimary careLatino patientsFree and Cued Selective Reminding TestMini Mental State Exam
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 20 , Issue 8 , September 2014 , pp. 848 - 855
Copyright
Copyright © The International Neuropsychological Society 2014 

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