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How to choose the most appropriate cognitive test to evaluate cognitive complaints in primary care

BACKGROUND: Despite the wealth of research devoted to the performance of individual cognitive tests for diagnosing cognitive impairment (including mild cognitive impairment and dementia), it can be difficult for general practitioners to choose the most appropriate test for a patient with cognitive c...

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Autores principales: Janssen, Jolien, Koekkoek, Paula S., Moll van Charante, Eric P., Jaap Kappelle, L., Biessels, Geert Jan, Rutten, Guy E. H. M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5732477/
https://www.ncbi.nlm.nih.gov/pubmed/29246193
http://dx.doi.org/10.1186/s12875-017-0675-4
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author Janssen, Jolien
Koekkoek, Paula S.
Moll van Charante, Eric P.
Jaap Kappelle, L.
Biessels, Geert Jan
Rutten, Guy E. H. M.
author_facet Janssen, Jolien
Koekkoek, Paula S.
Moll van Charante, Eric P.
Jaap Kappelle, L.
Biessels, Geert Jan
Rutten, Guy E. H. M.
author_sort Janssen, Jolien
collection PubMed
description BACKGROUND: Despite the wealth of research devoted to the performance of individual cognitive tests for diagnosing cognitive impairment (including mild cognitive impairment and dementia), it can be difficult for general practitioners to choose the most appropriate test for a patient with cognitive complaints in daily practice. In this paper we present a diagnostic algorithm for the evaluation of cognitive complaints in primary care. The rationale behind this algorithm is that the likelihood of cognitive impairment -which can be determined after history taking and an informant interview- should determine which cognitive test is most suitable. METHODS: We distinguished three likelihoods of cognitive impairment: not likely, possible or likely. We selected cognitive tests based on pre-defined required test features for each of these three situations and a review of the literature. We incorporated the cognitive tests in a practical diagnostic algorithm. RESULTS: Based on the available literature, in patients with complaints but where cognitive impairment is considered to be unlikely the clock-drawing test can be used to rule out cognitive impairment. When cognitive impairment is possible the Montreal cognitive assessment can be used to rule out cognitive impairment or to make cognitive impairment more likely. When cognitive impairment is likely the Mini-Mental State Examination can be used to confirm the presence of cognitive impairment. CONCLUSIONS: We propose a diagnostic algorithm to increase the efficiency of ruling out or diagnosing cognitive impairment in primary care. Further study is needed to validate and evaluate this stepwise diagnostic algorithm.
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spelling pubmed-57324772017-12-21 How to choose the most appropriate cognitive test to evaluate cognitive complaints in primary care Janssen, Jolien Koekkoek, Paula S. Moll van Charante, Eric P. Jaap Kappelle, L. Biessels, Geert Jan Rutten, Guy E. H. M. BMC Fam Pract Research Article BACKGROUND: Despite the wealth of research devoted to the performance of individual cognitive tests for diagnosing cognitive impairment (including mild cognitive impairment and dementia), it can be difficult for general practitioners to choose the most appropriate test for a patient with cognitive complaints in daily practice. In this paper we present a diagnostic algorithm for the evaluation of cognitive complaints in primary care. The rationale behind this algorithm is that the likelihood of cognitive impairment -which can be determined after history taking and an informant interview- should determine which cognitive test is most suitable. METHODS: We distinguished three likelihoods of cognitive impairment: not likely, possible or likely. We selected cognitive tests based on pre-defined required test features for each of these three situations and a review of the literature. We incorporated the cognitive tests in a practical diagnostic algorithm. RESULTS: Based on the available literature, in patients with complaints but where cognitive impairment is considered to be unlikely the clock-drawing test can be used to rule out cognitive impairment. When cognitive impairment is possible the Montreal cognitive assessment can be used to rule out cognitive impairment or to make cognitive impairment more likely. When cognitive impairment is likely the Mini-Mental State Examination can be used to confirm the presence of cognitive impairment. CONCLUSIONS: We propose a diagnostic algorithm to increase the efficiency of ruling out or diagnosing cognitive impairment in primary care. Further study is needed to validate and evaluate this stepwise diagnostic algorithm. BioMed Central 2017-12-16 /pmc/articles/PMC5732477/ /pubmed/29246193 http://dx.doi.org/10.1186/s12875-017-0675-4 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Janssen, Jolien
Koekkoek, Paula S.
Moll van Charante, Eric P.
Jaap Kappelle, L.
Biessels, Geert Jan
Rutten, Guy E. H. M.
How to choose the most appropriate cognitive test to evaluate cognitive complaints in primary care
title How to choose the most appropriate cognitive test to evaluate cognitive complaints in primary care
title_full How to choose the most appropriate cognitive test to evaluate cognitive complaints in primary care
title_fullStr How to choose the most appropriate cognitive test to evaluate cognitive complaints in primary care
title_full_unstemmed How to choose the most appropriate cognitive test to evaluate cognitive complaints in primary care
title_short How to choose the most appropriate cognitive test to evaluate cognitive complaints in primary care
title_sort how to choose the most appropriate cognitive test to evaluate cognitive complaints in primary care
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5732477/
https://www.ncbi.nlm.nih.gov/pubmed/29246193
http://dx.doi.org/10.1186/s12875-017-0675-4
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