Diagnostic Accuracy of the Telephone Interview for Cognitive Status for the Detection of Dementia in Primary Care

Herrer Abdulrahman, Eva Jansen, M. Hoevenaar-Blom, J. V. van Dalen, L. V. van Wanrooij, E. V. van Bussel, W. V. van Gool, E. Richard, E. P. Moll van Charante
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引用次数: 2

Abstract

PURPOSE Cognitive diagnostic work-up in primary care is not always physically feasible, owing to chronic disabilities and/or travel restrictions. The identification of dementia might be facilitated with diagnostic instruments that are time efficient and easy to perform, as well as useful in the remote setting. We assessed whether the Telephone Interview for Cognitive Status (TICS) might be a simple and accurate alternative for remote diagnostic cognitive screening in primary care. METHODS We administered the TICS (range, 0-41) for 810 of 1,473 older people aged 84.5 (SD, 2.4) years. We scrutinized electronic health records for participants with TICS scores ≤30 and for a random sample of participants with TICS scores >30 for a dementia diagnosis using all data from the Prevention of Dementia by Intensive Vascular Care (preDIVA) trial for 8-12 years of follow-up. We used multiple imputation to correct for verification bias. RESULTS Of the 810 participants, 155 (19.1%) had a TICS score ≤30, and 655 (80.9%) had a TICS score >30. Electronic health records yielded 8.4% (13/154) dementia diagnoses for participants with TICS ≤30 vs none with TICS >30. Multiple imputation for TICS >30 yielded a median of 7/655 (1.1%; interquartile range, 5-8) estimated dementia cases. After multiple imputation, the optimal cutoff score was ≤29, with mean sensitivity 65.4%, specificity 87.8%, positive predictive value 11.9%, negative predictive value 99.0%, and area under the curve 77.4% (95% CI, 56.3%-90.0%). CONCLUSIONS In the present older population, the TICS performed well as a diagnostic screening instrument for excluding dementia and might be particularly useful when face-to-face diagnostic screening is not feasible in family practice or research settings. The potential reach to large numbers of people at low cost could contribute to more efficient medical management in primary care.
初级保健中认知状态电话访谈诊断痴呆的准确性
由于慢性残疾和/或旅行限制,初级保健中的认知诊断检查在身体上并不总是可行的。使用快捷、易于操作、在远程环境中也很有用的诊断仪器,可以促进痴呆症的识别。我们评估了认知状态电话访谈(TICS)是否可能是初级保健中远程诊断认知筛查的一种简单而准确的替代方法。方法:我们对1473名年龄84.5 (SD, 2.4)岁的老年人中的810人进行了TICS(范围0-41)。我们仔细检查了tic评分≤30的参与者的电子健康记录,以及tic评分>30的参与者的痴呆诊断随机样本,使用来自强化血管护理预防痴呆(preDIVA)试验的8-12年随访的所有数据。我们使用多重输入来纠正验证偏差。结果:810名受试者中,155名(19.1%)患者的TICS评分≤30,655名(80.9%)患者的TICS评分>30。在TICS≤30和TICS >30的参与者中,电子健康记录的痴呆诊断率为8.4%(13/154)。对tic >30的多次代入的中位数为7/655 (1.1%;四分位数范围,5-8)估计痴呆病例。经多次拟合后,最佳临界值≤29分,平均敏感性65.4%,特异性87.8%,阳性预测值11.9%,阴性预测值99.0%,曲线下面积77.4% (95% CI 56.3% ~ 90.0%)。结论:在目前的老年人群中,tic作为排除痴呆的诊断筛查工具表现良好,当面对面诊断筛查在家庭实践或研究环境中不可行的时候可能特别有用。以低成本接触到大量人群的潜力可能有助于提高初级保健的医疗管理效率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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