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Three-question dementia screening

Development of the Salzburg Dementia Test Prediction (SDTP)

Drei-Fragen-Demenz-Screening

Entwicklung der Salzburger Demenztestvorhersage (SDTP)

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Zeitschrift für Gerontologie und Geriatrie Aims and scope Submit manuscript

Abstract

Background

To date, short dementia screenings are often limited by poor specificity or still take too much time with respect to the restricted resources of primary care physicians and the increasing number of dementia disorders. As a new instrument, the three-question dementia screening (SDTP, Salzburg Dementia Test Prediction) should be compared with the eight-item screening of Chen et al. and the CERAD battery (Consortium to Establish a Registry for Alzheimer’s Disease), focusing on specificity and economy of time.

Materials and methods

We tested 404 patients (243 women). The mean age of the subjects was 80.1 years (SD = 6.8) for men and 83.2 years (SD = 6.0) for women. The mean Mini-Mental State Examination (MMSE) score was 21.9 (SD =  5.8) for men and 21.1 (SD =  6.3) for women. Artificial neural networks (ANNs) were used to find a mathematical model that allows the total MMSE to be predicted with only three questions of the MMSE. This is achieved by multiplying the outcome of the three best predictor questions with a weighting coefficient, which was delineated by using ANNs.

Results

The Salzburg Dementia Test Prediction (SDTP) had a sensitivity of 94 % (95 % CI: 87–97 %) for screening of possible dementia, when the MMSE (MMSE < 25/30) was used as the reference test method and 96 % when the CERAD was used. The specificity was 68 % (95 % CI: 57–77 %) if the MMSE was used and 70 % if the whole test battery (CERAD) was used, which is as sensitive as and more specific than the eight-item screening.

Conclusion

The SDTP is a time-saving instrument for screening of dementia, which is as sensitive as and more specific than the eight-item screening of Chen et al. and provides a prediction of the MMSE with high accuracy.

Zusammenfassung

Hintergrund

Kurze Demenz-Screenings haben oft eine niedrige Spezifität oder nehmen zu viel Zeit in Anspruch, um im ärztlichen Routine-Setting durchgeführt zu werden. Als ein neues Instrument soll das Drei-Fragen-Demenz-Screening SDTP (Salzburger Demenztestvorhersage) mit dem 8-Punkte-Screening und der CERAD-Batterie („Consortium to Establish a Registry for Alzheimer’s Disease“) verglichen werden, v. a. in Hinblick auf Spezifität und Durchführungsdauer.

Material und Methoden

Es wurden 404 Patienten (243 Frauen) getestet. Das mittlere Alter betrug bei Männern 80,1 (SD = 6,8) und bei Frauen 83,2 Jahre (SD = 6,0). Der MMSE („Mini-Mental State Examination“) lag bei 21,9 (SD = 5,8) für Männer und bei 21,1 (SD = 6,3) für Frauen. Künstliche neuronale Netze („artificial neural networks“ – ANN) wurden verwendet, um ein mathematisches Modell zu erstellen, mit dem sich der MMSE mit nur drei Fragen vorhersagen lässt. Dies wird durch Multiplikation der Ergebnisse der drei besten Vorhersage-Fragen des MMSE mit einem Gewichtungskoeffizienten erreicht.

Ergebnisse

Die resultierende Salzburg-Demenztest-Prädiktion (SDTP) hat eine Sensitivität von 94 % (95 % CI: 87–97 %) für das Screening von Demenz, bei MMSE als Diagnosekriterium (MMSE < 25/30) und 96 %, wenn die CERAD zur Diagnosestellung verwendet wurde. Die Spezifität betrug 68 % (95 % CI: 57–77 %) beim Kriterium MMSE und 70 % bei der Verwendung der gesamten Testbatterie (CERAD). Die SDTP ist somit sensitiver und spezifischer als das 8-Punkte-Screening.

Schlussfolgerung

Die SDTP ist ein zeitsparendes Instrument zum Screening von Demenz, das sensitiver und spezifischer als das 8-Punkte-Screening ist und mit hoher Genauigkeit den MMSE vorhersagen kann.

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Acknowledgments

A.K. Kaiser thanks Prof. Michael Doppelmayr, Ms. Elisabeth Schmid for helping to collect the data, his twin brother Mr. Wolfgang Kaiser, Mr. Martin Plöderl, and Ms. Eva-Maria Kubin for proofreading the article, and his wife, Riki Kaiser, for enduring discussions about the topic in their spare time. Mr. A.K. Kaiser was responsible for the conception and performance of the study. He was also responsible for most of the written text. Mr. W. Hitzl was responsible for the final statistical design and the text in the Methods section. Mr. B. Iglseder was responsible for the general study design and final version of the manuscript.

Compliance with ethical guidelines

Conflict of interest. A.K. Kaiser, W. Hitzl, and B. Iglseder state that there are no conflicts if interest. All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form).

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Authors and Affiliations

  1. Department of Geriatric Medicine, Salzburger Landeskliniken Betriebs GesmbH, Christian-Doppler-Klinik, Paracelsus Medical University, Ignaz-Harrer-Str. 79, 5020, Salzburg, Austria

    A.K. Kaiser

  2. Department of Clinical Psychology, Salzburger Landeskliniken Betriebs GesmbH, Christian-Doppler-Klinik, Paracelsus Medical University, Salzburg, Austria

    A.K. Kaiser & B. Iglseder

  3. Research Office, Biostatistics, Paracelsus Medical University, Salzburg, Austria

    W. Hitzl

Authors
  1. A.K. Kaiser
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  2. W. Hitzl
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  3. B. Iglseder
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Correspondence to A.K. Kaiser.

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Kaiser, A., Hitzl, W. & Iglseder, B. Three-question dementia screening. Z Gerontol Geriat 47, 577–582 (2014). https://doi.org/10.1007/s00391-013-0568-7

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  • DOI: https://doi.org/10.1007/s00391-013-0568-7

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