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      Screening for cognitive impairment among individuals aged 60 years or over: scoping review

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          Abstract

          BACKGROUND:

          Growth in aging of the population has led to increasing numbers of elderly people presenting cognitive impairment and evolution to dementia. There is still no consensus within primary care on the best strategy for screening for cognitive impairment among elderly people. Standardization of a simple but reasonably accurate instrument for a brief cognitive test, in primary care environments, would enable healthcare professionals to identify individuals who require a more in-depth assessment of cognition.

          OBJECTIVES:

          To investigate the instruments used by healthcare professionals in studies conducted worldwide and ascertain the most suitable instruments for screening for cognitive impairment among individuals aged 60 years or over, in the Brazilian population.

          DESIGN AND SETTING:

          Scoping review developed at Pontifícia Universidade Católica de São Paulo, Brazil.

          METHOD:

          A systematic search of the literature was conducted for primary studies using instruments to screen for cognitive impairment among individuals aged 60 years or over, in the MEDLINE, EMBASE, Cochrane Central and LILACS databases.

          RESULTS:

          A total of 983 articles were identified by two independent reviewers, from which 49 were selected for full-text reading, based on the criteria defined for this review. From this, 16 articles adhering to the theme of screening for cognitive impairment among the elderly were selected for in-depth analysis.

          CONCLUSION:

          The Mini-Mental State Examination was the instrument most cited in these studies. The Pfeffer Functional Activities Questionnaire and the Verbal Fluency Test (semantic category) present characteristics favoring further studies, for testing as screening instruments for cognitive impairment among elderly people in Brazil.

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          Most cited references90

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          The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment.

          To develop a 10-minute cognitive screening tool (Montreal Cognitive Assessment, MoCA) to assist first-line physicians in detection of mild cognitive impairment (MCI), a clinical state that often progresses to dementia. Validation study. A community clinic and an academic center. Ninety-four patients meeting MCI clinical criteria supported by psychometric measures, 93 patients with mild Alzheimer's disease (AD) (Mini-Mental State Examination (MMSE) score > or =17), and 90 healthy elderly controls (NC). The MoCA and MMSE were administered to all participants, and sensitivity and specificity of both measures were assessed for detection of MCI and mild AD. Using a cutoff score 26, the MMSE had a sensitivity of 18% to detect MCI, whereas the MoCA detected 90% of MCI subjects. In the mild AD group, the MMSE had a sensitivity of 78%, whereas the MoCA detected 100%. Specificity was excellent for both MMSE and MoCA (100% and 87%, respectively). MCI as an entity is evolving and somewhat controversial. The MoCA is a brief cognitive screening tool with high sensitivity and specificity for detecting MCI as currently conceptualized in patients performing in the normal range on the MMSE.
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            "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician.

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              The Clinical Dementia Rating (CDR): current version and scoring rules.

              J Morris (1993)
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                Author and article information

                Contributors
                Role: conceived and designed the study, performed the review, analyzed the data and wrote the manuscript;
                Role: conceived and designed the study, performed the review, analyzed the data and did writing-review and editing of the manuscript;
                Role: conceived and designed the experiments, performed the review, analyzed the data and did writing-review of the manuscript;
                Role: conceived and designed the experiments, performed the review, analyzed the data and did writing-review and editing of the manuscript.
                Journal
                Sao Paulo Med J
                Sao Paulo Med J
                Sao Paulo Med J
                São Paulo Medical Journal
                Associação Paulista de Medicina - APM
                1516-3180
                1806-9460
                16 July 2021
                2021
                : 139
                : 5
                : 520-534
                Affiliations
                [I ] originalMD. Neurologist and Master’s Degree Student, Pontifícia Universidade Católica de São Paulo (PUC-SP), Sorocaba (SP), Brazil.
                [II ] originalMD, PhD. Speech Therapist, Audiology Specialist and Technical director, FONEC - Fonoaudiologia e Neurociência, Itapetininga (SP), Brazil.
                [III ] originalMD, PhD. Librarian, Information specialist at Cochrane Center in Brazil, São Paulo (SP), Brazil; and Director, Library Network, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
                [IV ] originalMD, PhD. Rheumatologist and Full Professor, Department of Internal Medicine, Pontifícia Universidade Católica de São Paulo (PUC-SP), Sorocaba (SP), Brazil.
                Author notes
                Address for correspondence: Patrícia Regina Piedade Feichtenberger, Pontifícia Universidade Católica de São Paulo (PUC-SP), R. Joubert Wey, 290, Sorocaba (SP) — Brasil, CEP 18030-070, Tel. (+55 15) 3212-9878 prpfeichtenberger@ 123456hotmail.com

                Authors’ contributions: All authors actively contributed to discussion of the results from the study, and reviewed and approved the final version to be released

                Conflict of interest: The authors declare that they did not have any conflict of interest

                Article
                10.1590/1516-3180.2020.0635.150321
                9632536
                34287510
                cce9b2c1-746c-4d63-bc13-49fd7217d2c1
                © 2022 by Associação Paulista de Medicina

                This is an open access article distributed under the terms of the Creative Commons license.

                History
                : 22 October 2020
                : 22 October 2020
                : 15 March 2021
                Page count
                Figures: 1, Tables: 5, Equations: 0, References: 72, Pages: 15
                Categories
                Narrative Review

                cognitive dysfunction,mass screening,aged,dementia,cognition,primary care,elderly,cognitive impairment

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