Brief initial evaluation of cognitive impairment: which tool to choose in general practice? review of literature

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Rochoy, Michaël | Leicht, Anne | Puszkarek, Thibault | Bordet, Regis | Chazard, Emmanuel | Favre, Jonathan

Edité par CCSD -

International audience. Memory complaints are difficult to integrate during a consultation in general medicine when they are not the main reason for consultation. In order to determine whether a dedicated consultation involving a long test is necessary, it is useful to have validated brief initial assessment tools for dementia (severe neurocognitive disorder) that can be integrated into the consultation.Objective. Determine the diagnostic values of screening tests that can be performed in less than five minutes, in order to determine the tests to be preferred in general medicine in France.Methods. We conducted a literature review on MEDLINE and LiSSa to identify the main tests that can be performed in less than 5 minutes for an initial assessment of cognitive disorders, and we included meta-analyses and original studies. We described how these tests are performed and reported their diagnostic values for the diagnosis of dementia, particularly as regards their sensitivity.Results. Eleven tests were identified in our review. The tests with the best sensitivities were found to be the CODEX (92% sensitivity; 95% CI [87; 95] out of 323 patients), Mini-CogTM (91 % sensitivity ; 95% CI [80; 96], out of 4178 patients), the IQ-CODE with a threshold of 3.4 (91% sensitivity; 95% CI [86; 94] out of 2745 patients) and the mental alternation test (95% sensitivity; 95% CI [86; 99] out of 113 patients).Conclusion. These tests make it possible to suggest dementia in less than 5 minutes, and encourage a more precise evaluation. Tests involving memorization and recall of 3 words interspersed with a clock test (CODEX and Mini-CogTM) seem to be excellent tools for the GP. The mental alternation test is simple and deserves further evaluation in general practice. As for the IQ-CODE, it reminds us of the importance of interviewing the patient’s family and friends, as well as longitudinal follow-up, in view of identifying a cognitive disorder in general medicine.

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