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Effectiveness and costs of phototest in dementia and cognitive impairment screening

Identifieur interne : 000555 ( Main/Exploration ); précédent : 000554; suivant : 000556

Effectiveness and costs of phototest in dementia and cognitive impairment screening

Auteurs : Cristobal Carnero-Pardo [Espagne] ; Beatriz Espejo-Martinez [Espagne] ; Samuel Lopez-Alcalde [Espagne] ; Maria Espinosa-Garcia [Espagne] ; Carmen Saez-Zea [Espagne] ; Rosa Vilchez-Carrillo [Espagne] ; Elisa Hernandez-Torres [Espagne] ; Jose L. Navarro-Espigares [Espagne]

Source :

RBID : PMC:3160880

Abstract

BackgroundTo assess and compare the effectiveness and costs of Phototest, Mini Mental State Examination (MMSE), and Memory Impairment Screen (MIS) to screen for dementia (DEM) and cognitive impairment (CI).MethodsA phase III study was conducted over one year in consecutive patients with suspicion of CI or DEM at four Primary Care (PC) centers. After undergoing all screening tests at the PC center, participants were extensively evaluated by researchers blinded to screening test results in a Cognitive-Behavioral Neurology Unit (CBNU). The gold standard diagnosis was established by consensus of expert neurologists. Effectiveness was assessed by the proportion of correct diagnoses (diagnostic accuracy [DA]) and by the kappa index of concordance between test results and gold standard diagnoses. Costs were based on public prices and hospital accounts.ResultsThe study included 140 subjects (48 with DEM, 37 with CI without DEM, and 55 without CI). The MIS could not be applied to 23 illiterate subjects (16.4%). For DEM, the maximum effectiveness of the MMSE was obtained with different cutoff points as a function of educational level [k = 0.31 (95% Confidence interval [95%CI], 0.19-0.43), DA = 0.60 (95%CI, 0.52-0.68)], and that of the MIS with a cutoff of 3/4 [k = 0.63 (95%CI, 0.48-0.78), DA = 0.83 (95%CI, 0.80-0.92)]. Effectiveness of the Phototest [k = 0.71 (95%CI, 0.59-0.83), DA = 0.87 (95%CI, 0.80-0.92)] was similar to that of the MIS and higher than that of the MMSE. Costs were higher with MMSE (275.9 ± 193.3€ [mean ± sd euros]) than with Phototest (208.2 ± 196.8€) or MIS (201.3 ± 193.4€), whose costs did not significantly differ. For CI, the effectiveness did not significantly differ between MIS [k = 0.59 (95%CI, 0.45-0.74), DA = 0.79 (95%CI, 0.64-0.97)] and Phototest [k = 0.58 (95%CI, 0.45-0.74), DA = 0.78 (95%CI, 0.64-0.95)] and was lowest for the MMSE [k = 0.27 (95%CI, 0.09-0.45), DA = 0.69 (95%CI, 0.56-0.84)]. Costs were higher for MMSE (393.4 ± 121.8€) than for Phototest (287.0 ± 197.4€) or MIS (300.1 ± 165.6€), whose costs did not significantly differ.ConclusionMMSE is not an effective instrument in our setting. For both DEM and CI, the Phototest and MIS are more effective and less costly, with no difference between them. However, MIS could not be applied to the appreciable percentage of our population who were illiterate.


Url:
DOI: 10.1186/1471-2377-11-92


Affiliations:


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Le document en format XML

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<name sortKey="Hernandez Torres, Elisa" sort="Hernandez Torres, Elisa" uniqKey="Hernandez Torres E" first="Elisa" last="Hernandez-Torres">Elisa Hernandez-Torres</name>
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<name sortKey="Navarro Espigares, Jose L" sort="Navarro Espigares, Jose L" uniqKey="Navarro Espigares J" first="Jose L" last="Navarro-Espigares">Jose L. Navarro-Espigares</name>
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<title>Background</title>
<p>To assess and compare the effectiveness and costs of Phototest, Mini Mental State Examination (MMSE), and Memory Impairment Screen (MIS) to screen for dementia (DEM) and cognitive impairment (CI).</p>
</sec>
<sec>
<title>Methods</title>
<p>A phase III study was conducted over one year in consecutive patients with suspicion of CI or DEM at four Primary Care (PC) centers. After undergoing all screening tests at the PC center, participants were extensively evaluated by researchers blinded to screening test results in a Cognitive-Behavioral Neurology Unit (CBNU). The gold standard diagnosis was established by consensus of expert neurologists. Effectiveness was assessed by the proportion of correct diagnoses (diagnostic accuracy [DA]) and by the kappa index of concordance between test results and gold standard diagnoses. Costs were based on public prices and hospital accounts.</p>
</sec>
<sec>
<title>Results</title>
<p>The study included 140 subjects (48 with DEM, 37 with CI without DEM, and 55 without CI). The MIS could not be applied to 23 illiterate subjects (16.4%). For DEM, the maximum effectiveness of the MMSE was obtained with different cutoff points as a function of educational level [k = 0.31 (95% Confidence interval [95%CI], 0.19-0.43), DA = 0.60 (95%CI, 0.52-0.68)], and that of the MIS with a cutoff of 3/4 [k = 0.63 (95%CI, 0.48-0.78), DA = 0.83 (95%CI, 0.80-0.92)]. Effectiveness of the Phototest [k = 0.71 (95%CI, 0.59-0.83), DA = 0.87 (95%CI, 0.80-0.92)] was similar to that of the MIS and higher than that of the MMSE. Costs were higher with MMSE (275.9 ± 193.3€ [mean ± sd euros]) than with Phototest (208.2 ± 196.8€) or MIS (201.3 ± 193.4€), whose costs did not significantly differ. For CI, the effectiveness did not significantly differ between MIS [k = 0.59 (95%CI, 0.45-0.74), DA = 0.79 (95%CI, 0.64-0.97)] and Phototest [k = 0.58 (95%CI, 0.45-0.74), DA = 0.78 (95%CI, 0.64-0.95)] and was lowest for the MMSE [k = 0.27 (95%CI, 0.09-0.45), DA = 0.69 (95%CI, 0.56-0.84)]. Costs were higher for MMSE (393.4 ± 121.8€) than for Phototest (287.0 ± 197.4€) or MIS (300.1 ± 165.6€), whose costs did not significantly differ.</p>
</sec>
<sec>
<title>Conclusion</title>
<p>MMSE is not an effective instrument in our setting. For both DEM and CI, the Phototest and MIS are more effective and less costly, with no difference between them. However, MIS could not be applied to the appreciable percentage of our population who were illiterate.</p>
</sec>
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</div1>
</back>
</TEI>
<affiliations>
<list>
<country>
<li>Espagne</li>
</country>
<region>
<li>Andalousie</li>
<li>Castille-La Manche</li>
</region>
</list>
<tree>
<country name="Espagne">
<region name="Andalousie">
<name sortKey="Carnero Pardo, Cristobal" sort="Carnero Pardo, Cristobal" uniqKey="Carnero Pardo C" first="Cristobal" last="Carnero-Pardo">Cristobal Carnero-Pardo</name>
</region>
<name sortKey="Carnero Pardo, Cristobal" sort="Carnero Pardo, Cristobal" uniqKey="Carnero Pardo C" first="Cristobal" last="Carnero-Pardo">Cristobal Carnero-Pardo</name>
<name sortKey="Espejo Martinez, Beatriz" sort="Espejo Martinez, Beatriz" uniqKey="Espejo Martinez B" first="Beatriz" last="Espejo-Martinez">Beatriz Espejo-Martinez</name>
<name sortKey="Espinosa Garcia, Maria" sort="Espinosa Garcia, Maria" uniqKey="Espinosa Garcia M" first="Maria" last="Espinosa-Garcia">Maria Espinosa-Garcia</name>
<name sortKey="Espinosa Garcia, Maria" sort="Espinosa Garcia, Maria" uniqKey="Espinosa Garcia M" first="Maria" last="Espinosa-Garcia">Maria Espinosa-Garcia</name>
<name sortKey="Hernandez Torres, Elisa" sort="Hernandez Torres, Elisa" uniqKey="Hernandez Torres E" first="Elisa" last="Hernandez-Torres">Elisa Hernandez-Torres</name>
<name sortKey="Lopez Alcalde, Samuel" sort="Lopez Alcalde, Samuel" uniqKey="Lopez Alcalde S" first="Samuel" last="Lopez-Alcalde">Samuel Lopez-Alcalde</name>
<name sortKey="Navarro Espigares, Jose L" sort="Navarro Espigares, Jose L" uniqKey="Navarro Espigares J" first="Jose L" last="Navarro-Espigares">Jose L. Navarro-Espigares</name>
<name sortKey="Saez Zea, Carmen" sort="Saez Zea, Carmen" uniqKey="Saez Zea C" first="Carmen" last="Saez-Zea">Carmen Saez-Zea</name>
<name sortKey="Saez Zea, Carmen" sort="Saez Zea, Carmen" uniqKey="Saez Zea C" first="Carmen" last="Saez-Zea">Carmen Saez-Zea</name>
<name sortKey="Vilchez Carrillo, Rosa" sort="Vilchez Carrillo, Rosa" uniqKey="Vilchez Carrillo R" first="Rosa" last="Vilchez-Carrillo">Rosa Vilchez-Carrillo</name>
</country>
</tree>
</affiliations>
</record>

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