Screening for dementia in community-based memory clinics.

PROBLEM Dementia is a significant public health problem that is underrecognized in primary care settings. This study examined the usefulness of 3 brief screening tests in detecting dementia and mild cognitive impairment (MCI) in persons seeking consultation for memory complaints within a network of memory diagnostic clinics in Wisconsin. METHODS This prospective study of consecutive referrals for memory diagnostic evaluation analyzed data for 364 patients > or = 50 years. Scores on 3 cognitive screening measures-the Mini-Mental State Examination (MMSE), Clock Drawing, and Animal Naming--were compared to clinical diagnosis of normal cognitive aging, MCI, or dementia. RESULTS Using the standard cut score of <24, the MMSE identified only 60% of persons diagnosed with dementia. By contrast, using a recommended cut score of <14 words per minute, Animal Naming identified 85% of persons with dementia with a relatively low (12%) false positive rate. Clock Drawing was intermediate to the other 2 measures in screening effectiveness. CONCLUSIONS Animal Naming was moderately to highly effective in identifying dementia. The naming procedure is easy to administer and may have value as a brief initial dementia screen in busy practice settings. More demanding cognitive measures may be needed to improve screening accuracy for MCI.