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Combined instruments for the screening of dementia in older people with low Education Translated title: Instrumentos combinados para o rastreio de demência em idosos com baixo nível educacional

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      Abstract

      OBJECTIVE: To determine which combination of cognitive tests and informant reports can improve the diagnostic accuracy of dementia screening in low educated older people. METHOD: Patients with mild to moderate dementia (n=34) according to ICD-10 and DSM-III-R criteria and 59 older controls were assessed with the Mini-Mental State Examination (MMSE) and the Fuld Object Memory Evaluation (FOME). Informants were assessed using the Informant Questionnaire on Cognitive Decline in the Elderly and the Bayer-Activities of Daily Living Scale. RESULTS: The 4 instruments combined with the mixed rule correctly classified 100% and the logistic regression (weighted sum) classified 95.7% of subjects. The weighted sum had a significantly larger ROC area compared to MMSE (p=0.008) and FOME (p=0.023). The specificity of the tested combinations was superior to the MMSE alone (p=0.002). CONCLUSIONS: Cognitive tests combined with informant reports can improve the screening of mild to moderate dementia in low educated older people.

      Translated abstract

      OBJETIVO: Determinar qual combinação de testes cognitivos e avaliações do informante pode melhorar o rastreio de demência em idosos com baixo nível educacional. MÉTODO: Pacientes com demência leve a moderada (n=34) de acordo com critérios da CID-10 e DSM-III-R, e 59 controles idosos foram avaliados com o Mini-Exame do Estado Mental (MEEM) e com o "Fuld Object Memory Evaluation" (FOME). Informantes foram avaliados com o "Informant Questionnaire on Cognitive Decline in the Elderly" e a escala Bayer-Atividades da Vida Diária. RESULTADOS: Os quatro instrumentos combinados com a regra mista classificaram 100% e a regressão logística (soma ponderada) classificou 95,7% dos sujeitos. A soma ponderada teve uma área da curva ROC significativamente maior comparada ao MEEM (p=0,008) e FOME (p=0,023). A especificidade das combinações testadas foi superior ao MEEM isolado (p=0,002). CONCLUSÕES: Testes cognitivos combinados com relatos dos informantes podem melhorar o rastreio de demência leve a moderada em idosos com baixo nível educacional.

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      Most cited references 27

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      "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician.

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        The Informant Questionnaire on cognitive decline in the elderly (IQCODE): a review.

        The IQCODE is widely used as a screening test for dementia, particularly where the subject is unable to undergo direct cognitive testing or for screening in populations with low levels of education and literacy. This review draws together research on the psychometric properties and validity of the IQCODE. A systematic search of the literature was carried out using three databases. The review shows that the questionnaire has high reliability and measures a single general factor of cognitive decline. It validly reflects past cognitive decline, performs at least as well at screening as conventional cognitive screening tests, predicts incident dementia, and correlates with a wide range of cognitive tests. A particular strength is that the IQCODE is relatively unaffected by education and pre-morbid ability or by proficiency in the culture's dominant language. The disadvantage of the IQCODE is that it is affected by informant characteristics such as depression and anxiety in the informant and the quality of the relationship between the informant and the subject. Because the IQCODE provides information complementary to brief cognitive tests, harnessing them together can improve screening accuracy.
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          Classificação de transtornos mentais e de comportamento da CID-10 - descrições clínicas e diretrizes diagnósticas

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            Author and article information

            Affiliations
            [1 ] Universidade de São Paulo Brazil
            [2 ] Universidade de São Paulo Brazil
            [3 ] Universidade de São Paulo Brazil
            [4 ] Universidade de São Paulo Brazil
            Contributors
            Role: ND
            Role: ND
            Role: ND
            Role: ND
            Role: ND
            Role: ND
            Role: ND
            Journal
            anp
            Arquivos de Neuro-Psiquiatria
            Arq. Neuro-Psiquiatr.
            Academia Brasileira de Neurologia - ABNEURO (São Paulo )
            1678-4227
            June 2009
            : 67
            : 2a
            : 185-190
            S0004-282X2009000200003
            10.1590/S0004-282X2009000200003

            http://creativecommons.org/licenses/by/4.0/

            Product
            Product Information: SciELO Brazil
            Categories
            NEUROSCIENCES
            PSYCHIATRY

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