This project addresses the urgent public health need for a dementia screening program in primary care settings where racial/ethnic minorities receive their medical care. Minority patients and patients with limited education are the very groups for whom the popular, commonly used mental status tests have poor sensitivity and specificity. To achieve the high sensitivity and specificity needed for efficient primary care-based screening and diagnosis, tests should be minimally influenced by differences in race/ethnicity and education and more sensitive to the memory impairment associated with very early dementia. Our long term objective is to design an efficient, culture-fair strategy to identify patients with incident and early dementia in primary care settings. We hypothesize that this will involve two steps: rapid screening of all geriatric patients followed by limited additional testing of patients who screen positive to establish memory impairment and one other cognitive disturbance as required by DSM IV criteria. We anticipate that both steps can be achieved with no more than 30 minutes of patient testing by a trained assistant. We anticipate that both steps can be achieved with no more tan 30 minutes of patient testing by a trained assistant. The clinician's time is conserved because a clinical evaluation is triggered only for patients who satisfy the neuropsychological criteria for DSM IV dementia. This makes early identification in primary care feasible. The objective of this small grant is to demonstrate that our culture-fair approach to early diagnosis is feasible and that we have reliable methods in place to support our planned RO1 application, a longitudinal of over 500 patients using the proposed methods in the same urban geriatric medicine clinic. Twenty-five African American and 25 Caucasian patients and their informants will be recruited and evaluated with the screening and diagnostic tests and followed-up 6 months later to confirm diagnosis. Diagnosis and clinical staging will be established by consensus of the PI, the neurologist, and the geriatrician independent of screening test results.
The specific aims are: 1) to provide preliminary estimates of the reliability of our clinical diagnoses; and 2) to provide preliminary estimates of the sensitivity and specificity of the screening tests in our clinic-based sample.
