Dementia screening Help

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mandy20
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Dementia screening Help

Post by mandy20 » Thu Dec 30, 2010 6:09 pm

Hi all,

I was wondering what are some good psychometric tests that could screen for dementia?? I'm hoping to assess a client and wanted a good one that may also be easy to get access to too.

Your help will be much appreciated...virtual chocolates & sweets :) :colors:

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ell
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Post by ell » Thu Dec 30, 2010 6:24 pm

Are you working in an older adult service? If so, surely they have some tests to hand - you could ask your supervisor which is the one the service currently uses? MMSE jumps to mind, although I believe the research shows this to be less helpful in screening for dementia than the widespread use of it would lead us to believe. Another one is the ACE-R (but you might need a proper version of that, I can't remember what the copyright is on it).

However, your question has raised some issues in my mind. If you aren't working in an older adult service (or even if you are tbh) there are a lot of issues to think about when looking at the possible diagnosis of dementia. For starters, dementia can't be diagnosed by psychometric test alone, and shouldn't be addressed by an AP/RA alone. Also, does the person know you are considering them to have a diagnosis like this? You need to let the person know what you are testing them for and what the consequences are of a diagnosis of dementia.

Apologies if you have already considered the above/the above is irrelevant for your clinical issue - just think it is important for people to understand the impact that a diagnosis of dementia has on a person.

L

e
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Post by e » Thu Dec 30, 2010 6:25 pm

The Mini-Mental State Examination (MMSE) is probably the most widely used.
You asked to screen for, not diagnose and the MMSE is pretty darn good at screening for dementia.

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ell
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Post by ell » Thu Dec 30, 2010 6:29 pm

When I am back at work I will look up the article I was reading that mentioned that the MMSE has an accuracy of between 50 and 60% in accurately detecting dementia.

I think those numbers are correct - I apologise to the MMSE and will give it a hug when I get back to work if not ;-)

L

charley
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Post by charley » Thu Dec 30, 2010 8:19 pm

The mmse is very poor at discriminating different types of dementias- the ace-r (Addenbrookes) can be found online and printed to use. It has cut off scores for screening - but you might need some help to interpret.

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baa
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Post by baa » Thu Dec 30, 2010 8:41 pm

Nah, don't hug the MMSE, it's not very good. I've no idea why people use it. Apart from it being short.
At least I'm not as mad as that one!

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Gilly
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Post by Gilly » Thu Dec 30, 2010 9:43 pm

the 6 item cognitive impairment test is better than the MMSE, according to oner of my old supervisors - and its available online in places (if you cant find it, PM me and ill send you it) - although we use the MMSE in our service (but its hilariously inaccurate, and vastly overused)

The ACE-R, as previously said, is freely available online and can screen for possible dementia, (but obviously cannot differentiate types) - it also incorporates the MMSE into it, and adds more items looking at naming, verbal fluency and mental flexibility - so its a good quick screen

[for actual diagnosis, you're going to need a combination of slightly more complex psychometrics, alongside a doctor and stuff :)]
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Gilly
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Post by Gilly » Thu Dec 30, 2010 9:46 pm

You're not calling for help, are you?! ;)

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Post by Lowri » Thu Dec 30, 2010 11:28 pm

Hmm, I'm a bit of an ACE-R fan if what you want is a bit of signposting to whether you need further tests or not.

The MMSE is rather poor, but it seems to be recognised and understood by a wide variety of people, including psychiatrists who might be reading your report. Sometimes, that seems to be one of the most important factors, especially if you're really only using the test (as you should be, really) to get an idea of a person's abilities. We used the ACE-R, particularly because it built on the MMSE. So, I'd probably suggest whichever test is used or best understood (if any) by others in your service, or even Trust.

I like the ACE-R because it's free and has pretty good patient acceptability (http://www.dementia-assessment.com.au/f ... ersion.pdf. Scoring guide is at http://egret.psychol.cam.ac.uk/medicine ... _guide.pdf).

We did find though that lots of different people might still interpret the scoring differently, so (as if it needs mentioning!) it's important to be able to understand what it is you're looking at, and to think about the pattern of strengths and weaknesses a person might show in their completion of the test.

A pretty nice thing about the ACE-R is that it signposts different items in the test that are intended to tap into certain processes, e.g. 'executive function' or 'visuospatial abilities' etc, and the scoring guide gives an idea of the lowest 'cut-off' point for each area that you might expect a person who seemed to be functioning 'normally' to receive. Hence, it gives you a 'picture' (albeit a broad, simplistic one), of the person's relative strengths and weaknesses in that sort of test, and so you can start to get an idea of what the person's finding relatively easier or more difficult and then think about how you might tailor your work with them from there ... rather than simply 'diagnosing'...

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mandy20
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Post by mandy20 » Fri Dec 31, 2010 2:21 am

Thanks for these suggestions and the links. I will be showing these to my supervisor first before the decision is made to use them. Really helpful guys, if you have any more suggestions please dont hold back! For those who wondered, the service i'm working in is Neuro, and we have the standard WAIS and WMS tests that i can use, but nothing specific for dementia screening.

Ta :)

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Gilly
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Post by Gilly » Fri Dec 31, 2010 11:47 am

we use a selection of tests from the WMS/WAIS alongside other tests to test for higher functioning dementia (in our service, people who score over 26 on the MMSE in our prescreen) - however these tests would be far too much for people who are in say, 'middle stage' dementia

if you're looking for a brief screen, then you cant go wrong with the MMSE or 6CIT - but the ACE-R is probably the best one to use

Also, you need to think about premorbid ability - if people score in the 'low average' range on your tests, then you need to determine whether that is due to the possible dementia or due to them being of a 'lower natural ability' - look at the wechsler test of adult reading / demographic equations (ill dig these up when i get home if you want?)
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mandy20
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Post by mandy20 » Sat Jan 01, 2011 6:01 pm

I've used the WAIS with the this client. Scored in the extremely low range. Thanks for suggesting investigating premorbid ability, I have access to the WTAR so may give that a go, if my supervisor ok's it. Thanks. :)

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Gilly
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Post by Gilly » Sat Jan 01, 2011 9:15 pm

no problem - in terms of dementia, the tests you want to pay particular attention to on the WAIS are block design and similarities, both of which are highly sensitive to it.

give me a shout if you need anything else - im up to my eyes in dementia testing at the moment, so its all in the front of my mind
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schizometric
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Post by schizometric » Sat Jan 01, 2011 9:49 pm

I'm jealous Gilly! In all my Neuro posts I've never worked in an OA service. Fingers crossed the course put me in one next time with a Neuro spin (as an aside, wonder if it's worth asking the course if there's a chance in hell they could if one's going spare, plenty people want more therapy oriented ones and I don't! :P)

Yeah, the MMSE is a load of pants. It's what psychiatrists ask you to do / think your job is, sometimes. You could use it but do it with caution and be aware of false negatives/positives. It always has to be followed up with something more in depth.

As Gilly says, subtests of the WMS and WAIS. Also the R-BANS is a little bit quicker but less .. crap than the MMSE :D I'm not a massive fan of the ACE-R even.. feel that it's too wishy washy, especially if you're looking for patterns of decline/relative strengths.
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Gilly
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Post by Gilly » Sat Jan 01, 2011 10:18 pm

definately try to get yourself into a memory clinic, our trainees also have plenty of OA therapy going, but i do love the neuropsych, and trying to tease out whether a dementia is AD, VaD, MCI or others is really interesting, lots of detective work :D

yeah, the RBANS is the other test we use, although the picture naming subtest on it is next to useless (graded naming test all the waaaaay!!)

im definately cut from neuropsych cloth :D
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