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Clinical Trial
. 2011 Jul 29:11:92.
doi: 10.1186/1471-2377-11-92.

Effectiveness and costs of phototest in dementia and cognitive impairment screening

Cristobal Carnero-Pardo  1 , Beatriz Espejo-Martinez, Samuel Lopez-Alcalde, Maria Espinosa-Garcia, Carmen Saez-Zea, Rosa Vilchez-Carrillo, Elisa Hernandez-Torres, Jose L Navarro-Espigares
Affiliations
Clinical Trial

Effectiveness and costs of phototest in dementia and cognitive impairment screening

Cristobal Carnero-Pardo et al. BMC Neurol. .

Abstract

Background: To assess and compare the effectiveness and costs of Phototest, Mini Mental State Examination (MMSE), and Memory Impairment Screen (MIS) to screen for dementia (DEM) and cognitive impairment (CI).

Methods: A phase III study was conducted over one year in consecutive patients with suspicion of CI or DEM at four Primary Care (PC) centers. After undergoing all screening tests at the PC center, participants were extensively evaluated by researchers blinded to screening test results in a Cognitive-Behavioral Neurology Unit (CBNU). The gold standard diagnosis was established by consensus of expert neurologists. Effectiveness was assessed by the proportion of correct diagnoses (diagnostic accuracy [DA]) and by the kappa index of concordance between test results and gold standard diagnoses. Costs were based on public prices and hospital accounts.

Results: The study included 140 subjects (48 with DEM, 37 with CI without DEM, and 55 without CI). The MIS could not be applied to 23 illiterate subjects (16.4%). For DEM, the maximum effectiveness of the MMSE was obtained with different cutoff points as a function of educational level [k = 0.31 (95% Confidence interval [95%CI], 0.19-0.43), DA = 0.60 (95%CI, 0.52-0.68)], and that of the MIS with a cutoff of 3/4 [k = 0.63 (95%CI, 0.48-0.78), DA = 0.83 (95%CI, 0.80-0.92)]. Effectiveness of the Phototest [k = 0.71 (95%CI, 0.59-0.83), DA = 0.87 (95%CI, 0.80-0.92)] was similar to that of the MIS and higher than that of the MMSE. Costs were higher with MMSE (275.9 ± 193.3€ [mean ± sd euros]) than with Phototest (208.2 ± 196.8€) or MIS (201.3 ± 193.4€), whose costs did not significantly differ. For CI, the effectiveness did not significantly differ between MIS [k = 0.59 (95%CI, 0.45-0.74), DA = 0.79 (95%CI, 0.64-0.97)] and Phototest [k = 0.58 (95%CI, 0.45-0.74), DA = 0.78 (95%CI, 0.64-0.95)] and was lowest for the MMSE [k = 0.27 (95%CI, 0.09-0.45), DA = 0.69 (95%CI, 0.56-0.84)]. Costs were higher for MMSE (393.4 ± 121.8€) than for Phototest (287.0 ± 197.4€) or MIS (300.1 ± 165.6€), whose costs did not significantly differ.

Conclusion: MMSE is not an effective instrument in our setting. For both DEM and CI, the Phototest and MIS are more effective and less costly, with no difference between them. However, MIS could not be applied to the appreciable percentage of our population who were illiterate.

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Figures

Figure 1
Figure 1
Phototest laminated sheet (version A).
Figure 2
Figure 2
Flow diagram of study participants. PC: Primary Care; CBNU: Cognitive Behavioral Neurology Unit; DEM: Dementia; CInD: Cognitive impairment without dementia; NoCI: No cognitive impairment.
Figure 3
Figure 3
Cost per correct diagnosis for dementia. MMSE: MiniMental State Examination. MMSEc: MMSE with corrected scores. MIS: Memory Impairment Screen. CD: correct diagnoses. *Cutoff points: 17/18: illiterates; 20/21: literate but did not complete primary schooling; 23/24: primary schooling or higher #Results for the 117 subjects who completed the MIS
Figure 4
Figure 4
Cost per correct diagnosis for cognitive impairment. MMSE: MiniMental State Examination. MMSEc: MMSE with corrected scores. MIS: Memory Impairment Screen. CD: correct diagnosis. *Cutoff points: 17/18: illiterates; 20/21: literate but did not complete primary schooling; 23/24: primary schooling or higher. #Results for the 117 subjects who completed the MIS
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References

    1. Petersen RC, Stevens JC, Ganguli M, Tangalos EG, Cummings JL, DeKosky ST. Practice parameter: early detection of dementia: mild cognitive impairment (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2001;56(9):1133–1142. - PubMed
    1. Boustani M, Peterson B, Hanson L, Harris R, Lohr KN. Screening for dementia in primary care: a summary of the evidence for the U.S. Preventive Services Task Force. Annals of internal medicine. 2003;138(11):927–937. - PubMed
    1. National Collaboration Centre for Mental Health. Dementia. A NICE-SCIE Guideline on supporting people with dementia and their carers in health and social care. National Clinical Practice Guideline Number 42. The British Psychological Society & The Royal College of Psychiatrists; 2007. - PubMed
    1. Carnero Pardo C. In: Neurología conductual: fundamentos teoricos y practicos. Manubens Bertran J, Berthier Torres M, Barquero Jiménez S, editor. Barcelona: Pulso Ediciones SL; 2002. Test de screening en demencia. - PubMed
    1. Ismail Z, Rajji TK, Shulman KI. Brief cognitive screening instruments: an update. Int J Geriatr Psychiatry. 2010;25(2):111–120. doi: 10.1002/gps.2306. - DOI - PubMed

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