Skip to main content
SpringerLink
Log in

The Rapid Cognitive Screen (RCS): A point-of-care screening for dementia and mild cognitive impairment

  • Published:
The journal of nutrition, health & aging

Abstract

Objectives

There is a need for a rapid screening test for mild cognitive impairment (MCI) and dementia to be used by primary care physicians. The Rapid Cognitive Screen (RCS) is a brief screening tool (< 3 min) for cognitive dysfunction. RCS includes 3-items from the Veterans Affairs Saint Louis University Mental Status (SLUMS) exam: recall, clock drawing, and insight. Study objectives were to: 1) examine the RCS sensitivity and specificity for MCI and dementia, 2) evaluate the RCS predictive validity for nursing home placement and mortality, and 3) compare the RCS to the clock drawing test (CDT) plus recall.

Methods

Patients were recruited from the St. Louis, MO Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Medical Center (VAMC) hospitals (study 1) or the Saint Louis University Geriatric Medicine and Psychiatry outpatient clinics (study 2). Study 1 participants (N=702; ages 65–92) completed cognitive evaluations and 76% (n=533/706) were followed up to 7.5 years for nursing home placement and mortality. Receiver operator characteristic (ROC) curves were computed to determine sensitivity and specificity for MCI (n=180) and dementia (n=82). Logistic regressions were computed for nursing home placement (n=31) and mortality (n=176). Study 2 participants (N=168; ages 60–90) completed the RCS and SLUMS exam. ROC curves were computed to determine sensitivity and specificity for MCI (n=61) and dementia (n=74).

Results

RCS predicted dementia and MCI in study 1 with optimal cutoff scores of ≤ 5 for dementia (sensitivity=0.89, specificity=0.94) and ≤ 7 for MCI (sensitivity=0.87, specificity=0.70). The CDT plus recall predicted dementia and MCI in study 1 with optimal cutoff scores of ≤ 2 for dementia (sensitivity=0.87, specificity=0.85) and ≤ 3 for MCI (sensitivity=0.62, specificity=0.62). Higher RCS scores were protective against nursing home placement and mortality. The RCS predicted dementia and MCI in study 2.

Conclusions

The 3-item RCS exhibits good sensitivity and specificity for the detection of MCI and dementia, and higher cognitive function on the RCS is protective against nursing home placement and mortality. The RCS may be a useful screening instrument for the detection of cognitive dysfunction in the primary care setting.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Alzheimer’s Association. Alzheimer’s Association Report: 2015 Alzheimer’s disease facts and figures. Alzheimers Dement 2015;11:332–384.

    Article  Google Scholar 

  2. Chodish J, Petitti DB, Elliott M, et al. Physician recognition of cognitive impairment: Evaluating the need for improvement. J Am Geriatr Soc 2004;52:1051–1059.

    Article  Google Scholar 

  3. Callahan CM, Hendrie HC, Tierney WM. Documentation and evaluation of cognitive impairment in elderly primary care patients. Ann Inter Med 1995;122:422–429.

    Article  CAS  Google Scholar 

  4. Valcour FB, Masaki KH, Curb JD, Blanchette PL. The detection of dementia in the primary care setting. Arch Intern Med 2000;160:2964–2968.

    Article  CAS  PubMed  Google Scholar 

  5. Boustani M, Callahan CM, Unverzagt FW, et al. Implementing a screening and diagnosis is program for dementia in primary care. J Gen Intern Med 2005;20:572–577.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Cordell CC, Borson S, Boustani M, et al. Alzheimer’s Association recommendations for operationalizing the detection of cognitive impairment during the Medicare Annual Wellness Visit in a primary care setting. Alzheimers Dement 2013;9:141–150.

    Article  PubMed  Google Scholar 

  7. Peterson RC. Mild cognitive impairment. N Engl J Med 2011;364;23:2227–2234.

    Article  Google Scholar 

  8. Langa, KM, Levine DA. The diagnosis and management of mild cognitive impairment. JAMA 2014;312:2251–2561.

    Article  Google Scholar 

  9. Morley JE. Mild cognitive impairment — a treatable condition. J Am Med Dir Assoc 2014;15:1–5.

    Article  PubMed  Google Scholar 

  10. Albert MS, DeKosky ST, Dickson D, et al. The diagnosis of mild cognitive impairment due to Alzheimer’s disease: Recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guideline for Alzheimer’s disease. Alzheimers Dement 2011;7:270–279.

    Article  PubMed Central  PubMed  Google Scholar 

  11. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th edition. Arlington, VA: American Psychiatric Publishing; 2013.

    Google Scholar 

  12. Dubois B, Feldman HH, Jacova C, et al. Revising the definition of Alzheimer’s disease: A new lexicon. Lancet Neurol 2010;9:1118–1127.

    Article  PubMed  Google Scholar 

  13. Ward A, Arrighi HM, Michels S, Cedarbaum JM. Mild cognitive impairment: Disparity of incidence and prevalence estimates. Alzheimers Dement. 2012;8:14–21.

    Article  PubMed  Google Scholar 

  14. Lin JS, O’Connor E, Rossom R, et al. Screening for cognitive impairment in older adults: An evidence update for the U.S. Preventive Services Task Force. Rockville, MD: Agency for Healthcare Research and Quality; 2013. Evidence Report 107. AHRQ Publication 14-05198-EF-1.

    Google Scholar 

  15. McCarten JR, Anderson P, Kuskowski MA, et al. Screening for cognitive impairment in an elderly veteran population: Acceptability and results using different versions of the Mini-Cog. J Am Geriatr Soc 2011;59:309–313.

    Article  PubMed  Google Scholar 

  16. Borson S, Scanlan JM, Chen P, Ganguli M. The Mini-Cog as a screen for dementia: Validation in a population-based sample. J Am Geriatr Soc 2003;51:1451–1454.

    Article  PubMed  Google Scholar 

  17. Lonie JA, Tierney KM, Ebmeier KP. Screening for mild cognitive impairment: A systematic review. Int J Geriatr Psychiatry 2009;24:902–915.

    Article  PubMed  Google Scholar 

  18. Tariq SH, Tumosa N, Chibnall JT, et al. Comparison of the Saint Louis University Mental Status Examination and the Mini-Mental State Examination for detecting dementia and mild neurocognitive disorder—a pilot study. Am J Geriatr Psychiatry 2006;14:900–910.

    Article  PubMed  Google Scholar 

  19. Cummings-Vaughn LA, Chavakula NN, Malmstrom TK, et al. Veterans Affairs Saint Louis University Mental Status examination compared with the Montreal Cognitive Assessment and the Short Test of Mental Status. J Am Geriatr Soc 2014;62:1341–1346.

    Article  PubMed  Google Scholar 

  20. Feliciano L, Horning SM, Klebe KJ, et al. Utility of the SLUMS as a cognitive screening tool among a nonveteran sample of older adults. Am J Geriatr Psychiatry 2013;21:623–630.

    Article  PubMed  Google Scholar 

  21. Cao L, Hai S, Lin X, et al. Comparison of the Saint Louis University Mental Status Examination, the Mini-Mental Status Examination, and the Montreal Cognitive Assessment in detection of cognitive impairment in Chinese elderly from the geriatric department. J Am Med Dir Assoc 2012;13:626–629.

    Article  PubMed  Google Scholar 

  22. Cruz-Oliver DM, Malmstrom TK, Allen CM, et al. The Veterans Affairs Saint Louis University Mental Status exam (SLUMS exam) and the Mini-mental status exam as predictors of mortality and institutionalization. J Nutr Health Aging 2012;16:636–641.

    Article  CAS  PubMed  Google Scholar 

  23. Kaufer DI, Williams CS, Braaten AJ, et al. Cognitive screening for dementia and mild cognitive impairment in assisted living: Comparison of 3 tests. J Am Med Dir Assoc 2008;9:586–593.

    Article  PubMed  Google Scholar 

  24. Holsinger T, Plassman BL, Stechuchak KM, et al. Screening for cognitive impairment: Comparing the performance of four instruments in primary care. J Am Geriatr Soc 2012;60:1027–1036.

    Article  PubMed  Google Scholar 

  25. Borson S, Scanlan JM, Watanabe J, et al. Improving identification of cognitive impairment in primary care. Int J Geriatr Psychiatry 2006;21:349–355.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology & Psychiatry, Saint Louis University School of Medicine, St. Louis, Missouri, USA

    Theodore K. Malmstrom & G. T. Grossberg

  2. Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA

    Theodore K. Malmstrom, D. M. Cruz-Oliver & J. E. Morley

  3. Saint Louis University School of Medicine, St. Louis, Missouri, USA

    V. B. Voss

  4. Jefferson Barracks Division, Geriatric Research Education and Clinical Center, Veterans Affairs Saint Louis Health System, St. Louis, Missouri, USA

    L. A. Cummings-Vaughn & N. Tumosa

  5. Division of Geriatrics and Nutritional Science, Washington University in St. Louis, St. Louis, Missouri, USA

    L. A. Cummings-Vaughn

  6. Department of Neurology & Psychiatry, School of Medicine, Saint Louis University, 1438 South Grand Boulevard, St. Louis, Missouri, 63104, USA

    Theodore K. Malmstrom

Authors
  1. Theodore K. Malmstrom
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. V. B. Voss
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D. M. Cruz-Oliver
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. L. A. Cummings-Vaughn
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. N. Tumosa
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. G. T. Grossberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J. E. Morley
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Theodore K. Malmstrom.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Malmstrom, T.K., Voss, V.B., Cruz-Oliver, D.M. et al. The Rapid Cognitive Screen (RCS): A point-of-care screening for dementia and mild cognitive impairment. J Nutr Health Aging 19, 741–744 (2015). https://doi.org/10.1007/s12603-015-0564-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12603-015-0564-2

Key words

Search

Navigation