In the Journals

New brief dementia screening tool shows comparable accuracy with gold standard

A newly developed brief screening tool for dementia accurately staged the disease without extensive training or clinician input and showed comparable accuracy to the Clinical Dementia Rating.

“All brief screening methods, whether informant-based (ie, the AD8) or performance-based (ie, the Mini-Cog), have limited ability to stage individuals,” James E. Galvin, MD, MPH, of the Charles E. Schmidt College of Medicine, Florida Atlantic University, wrote. “Gold standard evaluations (ie, Clinical Dementia Rating or CDR) … require a trained clinician to administer, interpret, and score; and an extended period of time with the patient and informant. Although feasible in the setting of a clinical trial, the CDR is more difficult to apply in screening procedures for inclusion/exclusion criteria or for case ascertainment in community-based research, and is impractical in most clinical practices.”

James E. Galvin, MD, MPH

James E. Galvin

Due to shortcomings of current dementia screening methods, Galvin developed the Quick Dementia Rating System (QDRS), a 10-item questionnaire that assesses memory and recall, orientation, decision-making and problem solving abilities, activity outside the home, function at home and hobbies, personal hygiene, behavior and personality changes, language and communication abilities, mood, and attention and concentration. The QDRS is completed by a caregiver, family member or friend. Scores range from 0 to 30, with higher scores representing greater cognitive impairment.

To test accuracy of the QDRS, Galvin administered the questionnaire to 267 patient-caregiver dyads and compared results with the CDR.

QDRS scores increased as CDR stages increased and neuropsychological performance deteriorated (P < .001).

The QDRS had low floor and ceiling effects, excellent known-groups validity across CDR stages (P < .001), construct validity against cognitive, behavioral and functional measures and reliability, according to Galvin.

The questionnaire exhibited differential scores across different dementia etiologies.

“Most patients never receive an evaluation by a neurologist, geriatric psychiatrist, or geriatrician skilled in dementia diagnoses and staging. Early detection will be important to enable future interventions at the earliest stages when they are likely to be most effective,” Galvin said in a press release. “The QDRS has the potential to provide a clearer, more accurate staging for those patients who are unable to see these more specialized clinicians and get them the treatment, referrals and community services they so desperately need.” – by Amanda Oldt

Disclosure: Galvin reports receiving research support from the NIH, Michael J Fox Foundation, the New York State Department of Health, the Morris and Alma Schapiro Fund, and a grant from the Applied Science Research Fund at NYU Langone Medical Center; serving as an investigator in clinical trials sponsored by the NIH, Merck, Eli Lilly, Takeda, Zinfandel, Neuronix, Lundbeck, and Medivante; receiving licensing fees from Novartis, Pfizer and Eisai for cocreation of the AD8; and holding the copyright for the Quick Dementia Rating System.

A newly developed brief screening tool for dementia accurately staged the disease without extensive training or clinician input and showed comparable accuracy to the Clinical Dementia Rating.

“All brief screening methods, whether informant-based (ie, the AD8) or performance-based (ie, the Mini-Cog), have limited ability to stage individuals,” James E. Galvin, MD, MPH, of the Charles E. Schmidt College of Medicine, Florida Atlantic University, wrote. “Gold standard evaluations (ie, Clinical Dementia Rating or CDR) … require a trained clinician to administer, interpret, and score; and an extended period of time with the patient and informant. Although feasible in the setting of a clinical trial, the CDR is more difficult to apply in screening procedures for inclusion/exclusion criteria or for case ascertainment in community-based research, and is impractical in most clinical practices.”

James E. Galvin, MD, MPH

James E. Galvin

Due to shortcomings of current dementia screening methods, Galvin developed the Quick Dementia Rating System (QDRS), a 10-item questionnaire that assesses memory and recall, orientation, decision-making and problem solving abilities, activity outside the home, function at home and hobbies, personal hygiene, behavior and personality changes, language and communication abilities, mood, and attention and concentration. The QDRS is completed by a caregiver, family member or friend. Scores range from 0 to 30, with higher scores representing greater cognitive impairment.

To test accuracy of the QDRS, Galvin administered the questionnaire to 267 patient-caregiver dyads and compared results with the CDR.

QDRS scores increased as CDR stages increased and neuropsychological performance deteriorated (P < .001).

The QDRS had low floor and ceiling effects, excellent known-groups validity across CDR stages (P < .001), construct validity against cognitive, behavioral and functional measures and reliability, according to Galvin.

The questionnaire exhibited differential scores across different dementia etiologies.

“Most patients never receive an evaluation by a neurologist, geriatric psychiatrist, or geriatrician skilled in dementia diagnoses and staging. Early detection will be important to enable future interventions at the earliest stages when they are likely to be most effective,” Galvin said in a press release. “The QDRS has the potential to provide a clearer, more accurate staging for those patients who are unable to see these more specialized clinicians and get them the treatment, referrals and community services they so desperately need.” – by Amanda Oldt

Disclosure: Galvin reports receiving research support from the NIH, Michael J Fox Foundation, the New York State Department of Health, the Morris and Alma Schapiro Fund, and a grant from the Applied Science Research Fund at NYU Langone Medical Center; serving as an investigator in clinical trials sponsored by the NIH, Merck, Eli Lilly, Takeda, Zinfandel, Neuronix, Lundbeck, and Medivante; receiving licensing fees from Novartis, Pfizer and Eisai for cocreation of the AD8; and holding the copyright for the Quick Dementia Rating System.