OBJECTIVES: To determine whether the Alzheimer's Disease Screen for Primary Care (ADS-PC) is more sensitive to early dementia than the Mini-Mental State Examination (MMSE) and whether it has as high a misclassification rate in minority patients and patients with limited education. DESIGN: Cross-sectional validation study. SETTING: Urban geriatric primary care practice. PARTICIPANTS: Three hundred sixteen African-American and Caucasian patients, including 55 patients with early dementia (Clinical Demential Rating of 0.5). MEASUREMENTS: The ADS-PC is a two-stage strategy for identifying early dementia that consists of a brief high-sensitivity dementia screen, applied to all patients aged 65 and older, and a second stage to identify memory impairment, applied to patients who fail the first stage. Differences in the sensitivities or specificities of the ADS-PC and the MMSE were evaluated using the McNemar test. RESULTS: Receiver operating characteristic curves were used to examine differences in the operating characteristics of the ADS-PC across a range of cutscores. When the specificities of both tests were equated (0.90), the sensitivities were significantly different (ADS-PC, 0.75; MMSE, 0.56). The MMSE failed to identify five times as many cases of dementia as the ADS-PC. When the sensitivities were equated, the specificities differed significantly (ADS-PC, 0.95; MMSE, 0.73). The MMSE misclassified five times as many noncases as the ADS-PC. This pattern of significantly higher sensitivity and specificity for the ADS-PC than for the MMSE was repeated in the results according to race and for individuals with high school or more education but not in individuals with less education. CONCLUSION: The ADS-PC outperformed the MMSE in identifying early dementia in a racially and educationally diverse primary care cohort.
OBJECTIVES: To determine whether the Alzheimer's Disease Screen for Primary Care (ADS-PC) is more sensitive to early dementia than the Mini-Mental State Examination (MMSE) and whether it has as high a misclassification rate in minority patients and patients with limited education. DESIGN: Cross-sectional validation study. SETTING: Urban geriatric primary care practice. PARTICIPANTS: Three hundred sixteen African-American and Caucasian patients, including 55 patients with early dementia (Clinical Demential Rating of 0.5). MEASUREMENTS: The ADS-PC is a two-stage strategy for identifying early dementia that consists of a brief high-sensitivity dementia screen, applied to all patients aged 65 and older, and a second stage to identify memory impairment, applied to patients who fail the first stage. Differences in the sensitivities or specificities of the ADS-PC and the MMSE were evaluated using the McNemar test. RESULTS: Receiver operating characteristic curves were used to examine differences in the operating characteristics of the ADS-PC across a range of cutscores. When the specificities of both tests were equated (0.90), the sensitivities were significantly different (ADS-PC, 0.75; MMSE, 0.56). The MMSE failed to identify five times as many cases of dementia as the ADS-PC. When the sensitivities were equated, the specificities differed significantly (ADS-PC, 0.95; MMSE, 0.73). The MMSE misclassified five times as many noncases as the ADS-PC. This pattern of significantly higher sensitivity and specificity for the ADS-PC than for the MMSE was repeated in the results according to race and for individuals with high school or more education but not in individuals with less education. CONCLUSION: The ADS-PC outperformed the MMSE in identifying early dementia in a racially and educationally diverse primary care cohort.
Authors: Ellen Grober; Wenzhu Bi Mowrey; Amy R Ehrlich; Peter Mabie; Steven Hahn; Richard B Lipton Journal: J Clin Exp Neuropsychol Date: 2016-06-07 Impact factor: 2.475
Authors: Beth E Snitz; Lisa A Morrow; Eric G Rodriguez; Kimberly A Huber; Judith A Saxton Journal: J Int Neuropsychol Soc Date: 2008-11 Impact factor: 2.892
Authors: Ellen Grober; Charles Hall; Maryanne McGinn; Toni Nicholls; Stephanie Stanford; Amy Ehrlich; Laurie G Jacobs; Gary Kennedy; Amy Sanders; Richard B Lipton Journal: J Int Neuropsychol Soc Date: 2008-01 Impact factor: 2.892