D r J u d i t h T a y l o r 1 , D r L a t a n a M u n a n g 2

1 N H S T a y s i d e , S c o t l a n d 2 N H S L o t h i a n , S c o t l a n d

The General Practitioner Assessment of Cognition (GPCOG): A Systematic

Review

Background

Early diagnosis and recognition of dementia

Characteristics of the ideal cognitive screening test?

Copyright issues with Mini Mental State Examination (MMSE)

GPCOG

Tool developed for dementia screening in a community population

Freely available online www.gpcog.com.au

Comprises 2 Steps 1) Cognitive Assessment

2) Informant Report

Longitudinal history

Step 1: Cognitive Test

GPCOG Screening Test

Step 1: Patient Examination Unless specified, each question should only be asked once

Name and Address for subsequent recall test 1. “I am going to give you a name and address. After I have said it, I want you to repeat

it. Remember this name and address because I am going to ask you to tell it to me again in a few minutes: John Brown, 42 West Street, Kensington.” (Allow a maximum of 4 attempts).

Time Orientation Correct Incorrect

2. What is the date? (exact only) Clock Drawing – use blank page

3. Please mark in all the numbers to indicate the hours of a clock (correct spacing required)

4. Please mark in hands to show 10 minutes past eleven o’clock (11.10)

Information

5. Can you tell me something that happened in the news recently? (Recently = in the last week. If a general answer is given, eg “war”, “lot of rain”, ask for det ails. Only specific answer scores).

Recall

6. What was the name and address I asked you to remember

John

Brown

42

West (St)

Kensington

© Universit –

Step 2: Informant Report

Review of the GPCOG

Is the GPCOG a valid cognitive screening method?

Inpatient validation?

How does GPCOG compare to other conventional cognitive assessment tools?

Method

Medline and embase search

Terms “GPCOG” and “general practitioner assessment of cognition”

Exclusion: study protocols, inaccessible review articles, conference abstracts

Data extracted: sensitivity, specificity, positive predictive value, mean time to completion, populations studied and gold standard comparisons

Results

20 abstracts were retrieved

13 full papers eligible for inclusion

6 original research articles

7 reviews

Study Heterogeneity

STUDY PATIENT GROUP EXCLUSION GOLD STANDARD

Brodaty et al 2002 & 2004

Community (n=283) Dementia diagnosis in 82

Nursing home Depression or delirium

Sensory impairment Poor English

DSM IV Diagnosis

Basic et al 2009

Community (n=151) Dementia diagnosis in 58

Cross-cultural

Delirium Severe sensory or physical

impairment

DSM IV Diagnosis

Pirani et al 2010

Community (n=210) Patient group n=132 Control group n=78

Nursing home Low education

Sensory impairment

DSM IV Diagnosis

Li et al 2013

Community (253) + Outpatients (103)

Dementia diagnosis in 78

Major depression/delirium Sensory impairment

DSM IV Diagnosis

Thomas et al 2006

Psychogeriatric inpatients (n=280)

Dementia diagnosis in 182

- DSM IV Diagnosis

Sensitivity and Specificity

STUDY GROUP SENSITIVITY (%)

SPECIFICITY (%)

POSITIVE PREDICTIVE VALUE (%)

Brodaty et al 2002 85 86 71

Basic et al 2009 98 77 -

Pirani et al 2010 88 92 95

Li et al 2013 97 89 72

Thomas et al 2006 96 62 83

Mean Time to Completion

Reported in 3 trials

3.0 to 3.5 minutes for the patient section

1.2 to 2.2 minutes for the informant section

Mean Time to Completion

Reported in 3 trials

3.0 to 3.5 minutes for the patient section

1.2 to 2.2 minutes for the informant section

Mean less than 5 minutes to complete both in all studies

Comparison

TOOL SENSITIVITY (%)

SPECIFICITY (%)

TIME TO COMPLETION

GPCOG (Brodaty et al 2002)

85 86 <5 mins

MMSE (Mitchell 2008)

78 87 5-10 mins

MOCA (Nasreddine 2005)

100 87 ~10 minutes

ACE-R (Hancock and Larner, 2011)

90 93 15-20 minutes

Reviews of Dementia Screening in Community Population

AUTHORS CRITERIA TOOLS

INCLUDED MOST PROMISING

Lorenz et al 2002

Efficacy Brevity Test short term memory

N=13 GPCOG Mini-COG MIS

Brodaty et al 2006

Validity in community Simple to administer Admin time <5 minutes Misclassification rate ≤ MMSE NPV ≥ MMSE

N=16 GPCOG Mini-COG MIS

Milne et al 2008

Scoring (out of 20): on Practicality Feasibility Range of applicability Psychometric properties

N=11 GPCOG (16) Mini-COG (16) MIS (15)

Informant Review

Brodaty et al 2002:

Informant review only available in 75% of cases.

Li et al 2013:

Lack of informant resulted in 41 exclusions (from initial 414 initially eligble participants)

GPCOG

STRENGTHS WEAKNESSES

Efficacy: comparable to MMSE Age bias

Rapid time to completion Challenges of fitting in with existing guidelines/clinician knowledge

Advantages of informant report

Challenge in availability of informant report

Acceptable to patients and GPs Not yet validated in general medical or geriatric inpatients

Tested in different languages / cultures

No education bias

Freely available online

Conclusions

GPCOG is a rapid and valid cognitive assessment tool in community populations

Compares favourably to commonly used cognitive assessment tools

Additional benefit of inclusion of informant history

Further Directions

Validation of cognitive asessment tools in the general inpatient population and nursing home population

Key Papers

Brodaty, H., Pond, D., Kemp, N. M., Luscombe, G., Harding, L., Berman, K., & Huppert, F. a. (2002). The GPCOG: a new screening test for dementia designed for general practice. Journal of the American Geriatrics Society, 50(3), 530–4.

Lorentz, W. J., Scanlan, J. M., & Borson, S. (2002). Brief screening tests for dementia. Canadian journal of psychiatry. 47(8), 723–33.

Brodaty, H., Kemp, N. M., & Low, L.-F. (2004). Characteristics of the GPCOG, a screening tool for cognitive impairment. International journal of geriatric psychiatry, 19(9), 870–4. doi:10.1002/gps.1167

Milne, A., Culverwell, A., Guss, R., Tuppen, J., & Whelton, R. (2008). Screening for

dementia in primary care: a review of the use, efficacy and quality of measures. International Psychogeriatrics, 20(05), 911–926.

Mitchell, A. J. (2009). A meta-analysis of the accuracy of the mini-mental state examination in the detection of dementia and mild cognitive impairment. Journal of psychiatric research, 43(4), 411–31.

judith.taylor@doctors.org.uk