Selecting a Brief Cognitive Screening Test Based on Patient Profile: It Is Never Too Early to Start

Abstract

Introduction: Cognitive impairment, marked by a decline in memory and attention, is frequently underdiagnosed, complicating effective management. Cardiovascular risk factors (CVR) and anticholinergic burden (ACB) are significant contributors to dementia risk, with ACB often stemming from medications prescribed for neuropsychiatric disorders. This study evaluates cognitive profiles through three brief cognitive tests, analyzing the impact of CVR and ACB presence. Methods: This cross-sectional study was performed between 2019 and 2023 in community pharmacies and an outpatient clinic in Valencia, Spain. Eligible participants were patients with subjective memory complaints 50 years or older with clinical records of cardiovascular factors. Patients with conflicting information regarding diabetes diagnosis or not taking concomitant medications were excluded. Three brief cognitive tests (Memory Impairment Screening (MIS), Semantic Verbal Fluency Test, and SPMSQ) were assessed. CVR was calculated using the European SCORE2 table, and ACB was assessed using the CALS scale. Results: Among 172 patients with memory complaints and CVR factors, 60% failed at least one cognitive test. These patients were on significantly more medications and had higher blood pressure and HbA1c levels. An increase in CVR and ACB was associated with more failed tests. Additionally, elevated SCORE2 scores were associated with a greater failure rate on the MIS test, while patients with elevated ACB more frequently failed the SPMSQ test. Conclusions: Selecting an adequate brief cognitive test according to patients' characteristics offers an opportunity to screen patients who are probably cognitively impaired. Whereas the MIS test may be helpful for patients with cardiovascular risk, SPMSQ stands out among patients with significant ACB.

Keywords: anticholinergic burden; cardiovascular risk; cognitive impairment; cognitive screening; neuropsychiatric disorder.

Figure 1

Participant selection diagram for this study. Created in BioRender. San Pablo CEU, F. (2024) BioRender.com. Group 1: High cardiovascular risk (CVR) and anticholinergic burden (ACB) ≥ 3 (red); Group 2: High CVR and ACB < 3 (orange); Group 3: No CVR and ACB ≥ 3 (purple); Group 4: No significant CVR and ACB < 3 (green, reference group). Dark purple indicates high CVR; light purple indicates ACB < 3, according to the CALS scale. Abbreviations: ACB: Anticholinergic Burden; HDL: High-Density Lipoprotein Cholesterol; CVR: Cardiovascular Risk; SBP: Systolic Blood Pressure.

Figure 2

Relationship between groups and the number of failed tests. Groups 1 and 3 have more patients failing one test, with a high anticholinergic burden (ACB). Group 1 has fewer patients failing one neuropsychological test than Group 3, but more patients fail all three tests. Groups 2 and 4 have a low ACB, with Group 2 having a high cardiovascular risk (CVR). Group 1: High CVR and ACB > 2 (red); Group 2: High CVR and ACB < 3 (orange); Group 3: No CVR and ACB > 2 (purple); Group 4: No significant CVR and ACB < 3 (green, reference group).