Case‐finding for cognitive impairment among people with Type 2 diabetes in primary care using the Test Your Memory and Self‐Administered Gerocognitive Examination questionnaires: the Cog‐ID study. Issue 6 (7th September 2015)

• Record Type: Journal Article
• Authors: Koekkoek, P. S.; Janssen, J.; Kooistra, M.; Biesbroek, J. M.; Groeneveld, O.; van den Berg, E.; Kappelle, L. J.; Biessels, G. J.; Rutten, G. E. H. M.
• Is Part Of: Diabetic medicine. Volume 33:Issue 6(2016:Jun.)
• Page Start: 812
• Page End: 819
• Publication Date: 2015-09-07
• Subjects: Diabetes -- Periodicals; 616.462
• DOI: 10.1111/dme.12874
• Languages: English
• ISSNs: 0742-3071

Abstract

Abstract: Aim: To evaluate two cognitive tests for case‐finding for cognitive impairment in older patients with Type 2 diabetes. Methods: Of 1243 invited patients with Type 2 diabetes, aged ≥70 years, 228 participated in a prospective cohort study. Exclusion criteria were: diagnosis of dementia; previous investigation at a memory clinic; and inability to write or read. Patients first filled out two self‐administered cognitive tests (Test Your Memory and Self‐Administered Gerocognitive Examination). Secondly, a general practitioner, blinded to Test Your Memory and Self‐Administered Gerocognitive Examination scores, performed a structured evaluation using the Mini‐Mental State Examination. Subsequently, patients suspected of cognitive impairment (on either the cognitive tests or general practitioner evaluation) and a random sample of 30% of patients not suspected of cognitive impairment were evaluated at a memory clinic. Diagnostic accuracy and area under the curve were determined for the Test Your Memory, Self‐Administered Gerocognitive Examination and general practitioner evaluation compared with a memory clinic evaluation to detect cognitive impairment (mild cognitive impairment or dementia). Results: A total of 44 participants were diagnosed with cognitive impairment. The Test Your Memory and Self‐Administered Gerocognitive Examination questionnaires had negative predictive values of 81 and 85%, respectively. Positive predictive values were 39 and 40%, respectively. The general practitioner evaluation had a negative predictive value of 83% and positive predictive value of 64%. The area under the curve was ~0.70 for all tests. Conclusions: Both the tests evaluated in the present study can easily be used in case‐finding strategies for cognitive impairment in patients with Type 2 diabetes in primary care. The Self‐Administered Gerocognitive Examination had the best diagnostic accuracy and therefore we would have a slight preference for this test. Applying the Self‐Administered Gerocognitive Examination would considerably reduce the number of patients in whom the general practitioner needs to evaluate cognitive functioning to tailor diabetes treatment. What's new?: Case‐finding for undiagnosed cognitive impairment in people with Type 2 diabetes, who are not unwilling to know their cognitive functioning, yields a significant number of people with cognitive impairment The self‐administered Test Your Memory and Self‐Administered Gerocognitive Examination questionnaires are appropriate tools as a first step in a case‐finding strategy to detect undiagnosed cognitive impairment in people with Type 2 diabetes in primary care. The use of one of these tests would considerably reduce the number of people in whom the general practitioner needs to evaluate cognitive functioning to detect undiagnosed cognitive impairment.