Improving identification of cognitive impairment in primary care

Soo Borson, James M. Scanlan, Jill Watanabe, Shin-Ping Tu, Mary Lessig

Research output: Contribution to journalArticle

125 Citations (Scopus)

Abstract

Objectives: To compare the relative level and predictors of accuracy of a brief cognitive screen, the Mini-Cog, with spontaneous detection of cognitive impairment by subjects' primary care physicians. Participants: A heterogeneous community sample (n = 371) of predominantly ethnic minority elderly assessed by standardized research protocol, 231 of whom met criteria for dementia or mild cognitive impairment (MCI). Results: The Mini-Cog detected cognitively impaired subjects much more effectively than did subject's own physicians (p < 0.0001), correctly classifying 83 % of the sample and 84% of cognitively impaired subjects. Physicians correctly classified 59% of all subjects but identified only 41 % of cognitively impaired subjects. The Mini-Cog's advantage over physicians was greatest when impairment was mildest (screen vs physician recognition at CDR 0.5, 58% vs 6%; at CDR 1,92% vs 41 %). Additional subject variables associated with missed detection by physicians were non-Alzheimer type dementia and low education, low literacy, and non-English speaking, factors that had little or no effect on the performance of the Mini-Cog. Ethnic differences, also observed for physician recognition, were not significant in final regression equations. The number and recency of primary care visits, and duration of the primary care relationship, were not associated with physicians' recognition of cognitive impairment. Conclusion: This study demonstrates that recognition of cognitive impairment by primary care physicians is adversely influenced by important patient and disease characteristics. Results also show that use of the Mini-Cog would improve recognition of cognitive impairment in primary care, particularly in milder stages and in older adults subject to disparities in health care quality due to sociodemographic factors.

Original languageEnglish (US)
Pages (from-to)349-355
Number of pages7
JournalInternational Journal of Geriatric Psychiatry
Volume21
Issue number4
DOIs
StatePublished - Apr 1 2006
Externally publishedYes

Fingerprint

Primary Health Care
Physicians
Primary Care Physicians
Dementia
Healthcare Disparities
Quality of Health Care
Cognitive Dysfunction
Education
Research

Keywords

  • Dementia screening
  • Ethnic minority
  • Health care disparity
  • Impairment
  • Language
  • Literacy
  • Mild cognitive

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Psychiatry and Mental health

Cite this

Improving identification of cognitive impairment in primary care. / Borson, Soo; Scanlan, James M.; Watanabe, Jill; Tu, Shin-Ping; Lessig, Mary.

In: International Journal of Geriatric Psychiatry, Vol. 21, No. 4, 01.04.2006, p. 349-355.

Research output: Contribution to journalArticle

Borson, Soo ; Scanlan, James M. ; Watanabe, Jill ; Tu, Shin-Ping ; Lessig, Mary. / Improving identification of cognitive impairment in primary care. In: International Journal of Geriatric Psychiatry. 2006 ; Vol. 21, No. 4. pp. 349-355.
@article{f7571d9d2c6b441da2bb42ec3dbcddbe,
title = "Improving identification of cognitive impairment in primary care",
abstract = "Objectives: To compare the relative level and predictors of accuracy of a brief cognitive screen, the Mini-Cog, with spontaneous detection of cognitive impairment by subjects' primary care physicians. Participants: A heterogeneous community sample (n = 371) of predominantly ethnic minority elderly assessed by standardized research protocol, 231 of whom met criteria for dementia or mild cognitive impairment (MCI). Results: The Mini-Cog detected cognitively impaired subjects much more effectively than did subject's own physicians (p < 0.0001), correctly classifying 83 {\%} of the sample and 84{\%} of cognitively impaired subjects. Physicians correctly classified 59{\%} of all subjects but identified only 41 {\%} of cognitively impaired subjects. The Mini-Cog's advantage over physicians was greatest when impairment was mildest (screen vs physician recognition at CDR 0.5, 58{\%} vs 6{\%}; at CDR 1,92{\%} vs 41 {\%}). Additional subject variables associated with missed detection by physicians were non-Alzheimer type dementia and low education, low literacy, and non-English speaking, factors that had little or no effect on the performance of the Mini-Cog. Ethnic differences, also observed for physician recognition, were not significant in final regression equations. The number and recency of primary care visits, and duration of the primary care relationship, were not associated with physicians' recognition of cognitive impairment. Conclusion: This study demonstrates that recognition of cognitive impairment by primary care physicians is adversely influenced by important patient and disease characteristics. Results also show that use of the Mini-Cog would improve recognition of cognitive impairment in primary care, particularly in milder stages and in older adults subject to disparities in health care quality due to sociodemographic factors.",
keywords = "Dementia screening, Ethnic minority, Health care disparity, Impairment, Language, Literacy, Mild cognitive",
author = "Soo Borson and Scanlan, {James M.} and Jill Watanabe and Shin-Ping Tu and Mary Lessig",
year = "2006",
month = "4",
day = "1",
doi = "10.1002/gps.1470",
language = "English (US)",
volume = "21",
pages = "349--355",
journal = "International Journal of Geriatric Psychiatry",
issn = "0885-6230",
publisher = "John Wiley and Sons Ltd",
number = "4",

}

TY - JOUR

T1 - Improving identification of cognitive impairment in primary care

AU - Borson, Soo

AU - Scanlan, James M.

AU - Watanabe, Jill

AU - Tu, Shin-Ping

AU - Lessig, Mary

PY - 2006/4/1

Y1 - 2006/4/1

N2 - Objectives: To compare the relative level and predictors of accuracy of a brief cognitive screen, the Mini-Cog, with spontaneous detection of cognitive impairment by subjects' primary care physicians. Participants: A heterogeneous community sample (n = 371) of predominantly ethnic minority elderly assessed by standardized research protocol, 231 of whom met criteria for dementia or mild cognitive impairment (MCI). Results: The Mini-Cog detected cognitively impaired subjects much more effectively than did subject's own physicians (p < 0.0001), correctly classifying 83 % of the sample and 84% of cognitively impaired subjects. Physicians correctly classified 59% of all subjects but identified only 41 % of cognitively impaired subjects. The Mini-Cog's advantage over physicians was greatest when impairment was mildest (screen vs physician recognition at CDR 0.5, 58% vs 6%; at CDR 1,92% vs 41 %). Additional subject variables associated with missed detection by physicians were non-Alzheimer type dementia and low education, low literacy, and non-English speaking, factors that had little or no effect on the performance of the Mini-Cog. Ethnic differences, also observed for physician recognition, were not significant in final regression equations. The number and recency of primary care visits, and duration of the primary care relationship, were not associated with physicians' recognition of cognitive impairment. Conclusion: This study demonstrates that recognition of cognitive impairment by primary care physicians is adversely influenced by important patient and disease characteristics. Results also show that use of the Mini-Cog would improve recognition of cognitive impairment in primary care, particularly in milder stages and in older adults subject to disparities in health care quality due to sociodemographic factors.

AB - Objectives: To compare the relative level and predictors of accuracy of a brief cognitive screen, the Mini-Cog, with spontaneous detection of cognitive impairment by subjects' primary care physicians. Participants: A heterogeneous community sample (n = 371) of predominantly ethnic minority elderly assessed by standardized research protocol, 231 of whom met criteria for dementia or mild cognitive impairment (MCI). Results: The Mini-Cog detected cognitively impaired subjects much more effectively than did subject's own physicians (p < 0.0001), correctly classifying 83 % of the sample and 84% of cognitively impaired subjects. Physicians correctly classified 59% of all subjects but identified only 41 % of cognitively impaired subjects. The Mini-Cog's advantage over physicians was greatest when impairment was mildest (screen vs physician recognition at CDR 0.5, 58% vs 6%; at CDR 1,92% vs 41 %). Additional subject variables associated with missed detection by physicians were non-Alzheimer type dementia and low education, low literacy, and non-English speaking, factors that had little or no effect on the performance of the Mini-Cog. Ethnic differences, also observed for physician recognition, were not significant in final regression equations. The number and recency of primary care visits, and duration of the primary care relationship, were not associated with physicians' recognition of cognitive impairment. Conclusion: This study demonstrates that recognition of cognitive impairment by primary care physicians is adversely influenced by important patient and disease characteristics. Results also show that use of the Mini-Cog would improve recognition of cognitive impairment in primary care, particularly in milder stages and in older adults subject to disparities in health care quality due to sociodemographic factors.

KW - Dementia screening

KW - Ethnic minority

KW - Health care disparity

KW - Impairment

KW - Language

KW - Literacy

KW - Mild cognitive

UR - http://www.scopus.com/inward/record.url?scp=33646201319&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33646201319&partnerID=8YFLogxK

U2 - 10.1002/gps.1470

DO - 10.1002/gps.1470

M3 - Article

C2 - 16534774

AN - SCOPUS:33646201319

VL - 21

SP - 349

EP - 355

JO - International Journal of Geriatric Psychiatry

JF - International Journal of Geriatric Psychiatry

SN - 0885-6230

IS - 4

ER -