In people with a minor decline on the Mini-Mental-State-Examination--a widely used but limited test to screen for cognitive defects--follow-up with a simple visual screening tool can help identify those at increased risk for dementia. As part of a cluster-randomized controlled trial, researchers in the Netherlands analyzed the MMSE of 2690 older adult patients at baseline and two-year follow-up. The Visual Association Test, consisting of six cue cards and six target cards showing an unexpected visual association, was also analyzed at the two-year follow-up. A decline in MMSE scores of two points and three points were associated with an increased risk of developing dementia of 10 percent and 21 percent respectively, significantly higher than the overall risk of developing dementia. Groups with imperfect VAT scores (?5 out of six) had substantially higher percentages of incident dementia. An imperfect VAT score increased the predictive value of two and three point decreases on the MMSE from 10 percent to 14 percent and from 21 percent to 29 percent respectively. Given the importance of timely diagnosis of dementia, the authors suggest that the VAT may help identify older persons who need further cognitive examination, especially those with a minor decline in MMSE score.
Improving Prediction of Dementia in Primary Care
Susan Jongstra, MD, PhD, et al
University of Amsterdam, The Netherlands