TY - JOUR T1 - Subjective Versus Objective Assessment of Cognitive Functioning in Primary Care JF - The Journal of the American Board of Family Medicine JO - J Am Board Fam Med SP - 417 LP - 425 DO - 10.3122/jabfm.2020.03.190265 VL - 33 IS - 3 AU - Courtney Hess AU - Boaz Levy AU - Ardeshir Z. Hashmi AU - Jacqueline Hogan AU - Sarah Greenspan AU - Allison Elber AU - Kathryn Falcon AU - Daniel F. Driscoll Y1 - 2020/05/01 UR - http://www.jabfm.org/content/33/3/417.abstract N2 - Purpose: This study examined the clinical utility of highly efficient subjective and objective screens of cognitive impairment.Method: Participants (N = 124, age ≥ 65, mean = 73.59, SD = 6.26) completed a 2-item questionnaire of subjective memory functioning, a brief computerized cognitive test, and the Montreal Cognitive Assessment (MoCA). Next, participants were assigned to 1 of 4 conditions, based on their subjective (low/high) and objective (impaired/unimpaired) levels of cognitive functioning. Further analysis divided the sample into age-based groups (ie, age < 75, age ≥ 75).Results: The proportion of participants in the impaired subsample (ie, MoCA < 26), who reported a high level of subjective concern about their memory, was low (ie, 0.15). Among unimpaired participants, analysis detected significant group differences across subjective memory levels (P < .0003) and age (P < .005) categories on one of the three tasks of the computerized test (ie, cognitive control). In contrast, the MoCA offered no differentiation between these groups.Conclusion: Screening protocols in which cognitive testing is administered subsequent to patient complaint are prone to underdiagnosis. In addition, common dementia screens are insensitive to subjective deficits and healthy cognitive aging. Therefore, they may lead to dismissing valid concerns that deserve preventive attention. Primary care needs efficient screening tools that are sensitive to prodromal decline. ER -