Significant weakness found in dementia screening method

Nov 7 2008

A research team led by Dr Alisoun Milne, a Senior Lecturer at the Tizard Centre, University of Kent, has identified weaknesses in the most widely employed dementia screening instrument currently used in primary care.

The team, which included three senior health care practitioners from the Kent and Medway NHS and Social Care Partnership Trust, conducted a study that included a review of research evidence, a systematic clinically informed evaluation of the most commonly used screening measures, and a survey of measures employed in primary care in Kent.

Although the survey revealed that the Mini Mental State Examination (MMSE) was the most widely used measure in Kent – with as many as 51% of respondents using it as the only screening tool – the review concluded that three other less commonly used instruments are easier to administer, clinically acceptable, more effective, and less affected by patient education, gender, and ethnicity. These are: the General Practitioner Assessment of Cognition (GPCOG), the Memory Impairment Screen (MIS), and the Mini-Cognitive Assessment Instrument (Mini-Cog). That all three have psychometric properties similar to the MMSE is also important.

Of the GPs surveyed, many actually expressed concern about limited availability of measures other than MMSE, little access to training and advice on screening, and a lack of national guidance. One GP summarised the views of many by stating that ‘it would be very helpful if a standard screening tool could be recommended and made widely available . . . now!'

Dr Milne, a researcher in the field of gerontology, said: ‘Although the MMSE is widely used in the UK, this project identifies the GPCOG, MIS and Mini-Cog as clinically and psychometrically robust and more appropriate for routine use in primary care. The study highlights a need for primary care staff to be offered training and advice on dementia screening including the use of instruments. Early diagnosis is one of the key aims of the National Dementia Strategy; improving the quality and consistency of dementia screening is a distinctive and yet pivotal dimension of achieving this important policy goal.'

Dr Milne also moved to reassure patients and family members who may have concerns about the findings. ‘Anyone with concerns about their own, or their relatives, cognitive function or memory should consult their GP,' she said. ‘Whatever the relative weaknesses of the MMSE are, it remains a safe and valid screening instrument. Further, it is likely to remain the instrument of choice for most GPs until national guidance is provided on dementia screening and early diagnosis taking account of evaluative clinically informed research of the type reported by us.'

‘Screening for dementia in primary care: a review of the use, efficacy and quality of measures' by A. Milne (Tizard Centre), A. Culverwell (St Martin's Hospital, Canterbury), R. Guss (Medway Maritime Hospital, Gillingham), J. Tuppen (The Beacon, Ramsgate) and R. Whelton (Tizard Centre) is published in the October issue, Vol. 20 (5), of International Psychogeriatrics, the official journal of the International Psychogeriatric Association.