Dataset Information

A Brief Informant Screening Instrument for Dementia in the ICU: The Diagnostic Accuracy of the AD8 in Critically Ill Adults Suspected of Having Pre-Existing Dementia.

ABSTRACT:

Background/aim

The diagnostic accuracy of brief informant screening instruments to detect dementia in critically ill adults is unknown. We sought to determine the diagnostic accuracy of the 2- to 3-min Ascertain Dementia 8 (AD8) completed by surrogates in detecting dementia among critically ill adults suspected of having pre-existing dementia by comparing it to the Clinical Dementia Rating Scale (CDR).

Methods

This substudy of BRAIN-ICU included a subgroup of 75 critically ill medical/surgical patients determined to be at medium risk of having pre-existing dementia (Informant Questionnaire on Cognitive Decline in the Elderly [IQCODE] score ≥3.3). We calculated the sensitivity, specificity, positive and negative predictive values (PPV and NPV), and AUC for the standard AD8 cutoff of ≥2 versus the reference standard CDR score of ≥1 for mild dementia.

Results

By the CDR, 38 patients had very mild or no dementia and 37 had mild dementia or greater. For diagnosing mild dementia, the AD8 had a sensitivity of 97% (95% CI 86-100), a specificity of 16% (6-31), a PPV of 53% (40-65), an NPV of 86% (42-100), and an AUC of 0.738 (0.626-0.850).

Conclusions

Among critically ill patients judged at risk for pre-existing dementia, the 2- to 3-min AD8 is highly sensitive and has a high NPV. These data indicate that the brief tool can serve to rule out dementia in a specific patient population.

SUBMITTER: Duggan MC

PROVIDER: S-EPMC9528182 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Publications

A Brief Informant Screening Instrument for Dementia in the ICU: The Diagnostic Accuracy of the AD8 in Critically Ill Adults Suspected of Having Pre-Existing Dementia.

Duggan Maria C MC Morrell Madeline E ME Chandrasekhar Rameela R Marra Annachiara A Frimpong Kwame K Nair Deepanjali R DR Girard Timothy D TD Pandharipande Pratik P PP Ely E Wesley EW Jackson James C JC

Dementia and geriatric cognitive disorders 20190101 5-6

<h4>Background/aim</h4>The diagnostic accuracy of brief informant screening instruments to detect dementia in critically ill adults is unknown. We sought to determine the diagnostic accuracy of the 2- to 3-min Ascertain Dementia 8 (AD8) completed by surrogates in detecting dementia among critically ill adults suspected of having pre-existing dementia by comparing it to the Clinical Dementia Rating Scale (CDR).<h4>Methods</h4>This substudy of BRAIN-ICU included a subgroup of 75 critically ill med ...[more]

PMID: 32259825

Similar Datasets

Project description:BackgroundDementia and mild cognitive impairment (MCI) are underrecognized in community settings. This may be due in part to the lack of brief dementia screening tools available to clinicians. We compared 2 brief, informant-based screening tests: the AD8 and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) in a community-based neurology practice in the midwestern United States.MethodsWe examined 186 consecutive patients (44 controls, 13 with MCI, and 129 with dementia). Receiver operator characteristic curves were used to examine the ability of AD8 and IQCODE to discriminate between controls and MCI or dementia. Sensitivity, specificity, predictive values, and likelihood ratios were reported.ResultsAD8 differentiated healthy controls from MCI (P<0.001) or dementia (P<0.001), and MCI from dementia (P=0.008). The IQCODE differentiated controls and MCI from dementia (both P<0.001), and between controls and MCI (P=0.002). Both AD8 (AUC=0.953; 95% confidence interval, 0.92-0.99) and IQCODE (AUC=0.930, 95% confidence interval, 0.88-0.97) provided discrimination between controls and patients with dementia; however, the AD8 had superior sensitivity detecting dementia (99.2%) and MCI (100%) compared with the IQCODE (79.1% for dementia, 46.1% for MCI) with nonoverlapping confidence intervals. Using published cut-offs (AD8≥2, IQCODE≥3.4), only 1 case of dementia was missed with the AD8, whereas the IQCODE failed to detect dementia in 27 individuals. The AD8 detected MCI in all 13 individuals, whereas the IQCODE misclassified 7 individuals.ConclusionsBoth the AD8 and IQCODE were able to detect dementia in a community setting. The AD8, however, was more successful than IQCODE in detecting MCI. If simple and efficient screening for early cognitive impairment is the goal, particularly in the early stages (e.g., for prevention trials or public screening), the combination of an informant interview (the AD8) and a brief performance measure could be considered as they meet the basic requirements of the Personalized Prevention Plan for Medicare beneficiaries.

Dataset Information

A Brief Informant Screening Instrument for Dementia in the ICU: The Diagnostic Accuracy of the AD8 in Critically Ill Adults Suspected of Having Pre-Existing Dementia.

Background/aim

Methods

Results

Conclusions

Publications

A Brief Informant Screening Instrument for Dementia in the ICU: The Diagnostic Accuracy of the AD8 in Critically Ill Adults Suspected of Having Pre-Existing Dementia.

Similar Datasets

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