RT Journal Article
SR Electronic
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
FD American Board of Family Medicine
SP 417
OP 425
DO 10.3122/jabfm.2020.03.190265
VO 33
IS 3
A1 Hess, Courtney
A1 Levy, Boaz
A1 Hashmi, Ardeshir Z.
A1 Hogan, Jacqueline
A1 Greenspan, Sarah
A1 Elber, Allison
A1 Falcon, Kathryn
A1 Driscoll, Daniel F.
YR 2020
UL http://www.jabfm.org/content/33/3/417.abstract
AB 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.