Distinguishing Early Dementia From Normal Aging

By Anne Harding

NEW YORK (Reuters Health) – A new model of normal cognitive decline that takes age and education into account can be used to identify patients in the early stages of dementia, according to a new report in CMAJ.

“Being able to screen these patients early, when they are only starting to fall off the curve, that’s really where you can intervene and have an impact,” Dr. Robert Laforce Jr. of the Universite Laval in Quebec, one of the study’s authors, told Reuters Health in a telephone interview.

Similar to the growth charts used in pediatricians’ offices, these predictive curves allow clinicians to track patients’ cognitive function over time, Dr. Laforce and his colleagues explain in their December 4 report. Their model is called QuoCo (cognitive quotient) and incorporates age, Mini Mental State Examination (MMSE) score, and education.

Many clinicians use the MMSE to screen their older patients for cognitive impairment, the researchers note, but how best to interpret these scores is not clear. “A clinical question that is often raised by physicians is ‘OK, we perform cognitive screening, but we don’t really know what it means,” Dr. Laforce said.

He and his colleagues used data from the Canadian Study of Health and Aging on 7,569 patients age 65 or older to develop charts showing normal cognitive decline over time. The charts were based on the MMSE, which study participants had completed at baseline and then five and 10 years later.

The cognitive charts had a baseline sensitivity of 80% and specificity of 89% for distinguishing between people with dementia and healthy controls.

Dr. Laforce and his team validated the model in a data set that included 6,501 people from the National Alzheimer’s Coordinating Center.

“Here is a simple, easy-to-use tool for all physicians to track the performance of their patients on cognitive tests over time,” the researcher said. “The next wave for us is to be able to have family physicians and dementia caretakers all over the world be able to use the QuoCo in their practice.”

Dr. Laforce said he and his colleagues are now developing cognitive curves to use with the Montreal Cognitive Assessment, which may be able to identify dementia earlier than the MMSE.

A mobile app based on the cognitive charts can be downloaded at https://bit.ly/2jeKO2o.

The study’s lead author, Dr. Patrick Bernier, holds a patent on the QuoCo app and the methods used to create it.

SOURCE: https://bit.ly/2jPimnw

CMAJ 2017.

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