A Comparison of Alternative Methods of Screening for Dementia in Clinical Settings

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Abstract
Objective: To compare 3 approaches to screening for dementia: cognitive testing, informant report, and neurovisual assessment in a clinical environment. Setting: A university hospital in Geneva, Switzerland. Patients: Subjects were 76 patients admitted to the Geriatric Hospital or outpatients assessed at the Memory Clinic of the Hospitals of the University of Geneva School of Medicine in Geneva, Switzerland. Thirty-three met criteria for dementia and 11 for depression based on theDiagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised. Main Outcome Measures: Performance in French-language versions of the Mini-Mental State Examination, the Informant Questionnaire on Cognitive Decline in the Elderly, and the Clinical Antisaccadic Eye Movement Test. Results: All tests significantly discriminated cases of dementia from noncases. The receiver operator characteristic analysis demonstrated that the Mini-Mental State Examination and the Informant Questionnaire on Cognitive Decline in the Elderly were more efficient screening measures for dementia than the Antisaccadic Eye Movement Test in this setting. Unlike the Mini-Mental State Examination, the Informant Questionnaire on Cognitive Decline in the Elderly was unrelated to patients' educational attainment or premorbid intelligence. The previously reported strong relationship between the Mini-Mental State Examination and the Antisaccadic Eye Movement Test was not replicated in these patients. Conclusions: Both cognitive testing and informant report are efficient methods of screening for dementia in clinical settings. Factors such as sensorimotor disability or informant availability may dictate the viability of each approach in individual application. The performance of the Antisaccadic Eye Movement Test precludes recommending its use as a screen for dementia without further research into its performance.