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Critical Appraisal Topic: The Use of Mini-Cog Screening Tool to Diagnose Alzheimer’s disease in the ElderlyMarjorie MastenUniversity of MaryCritical Appraisal Topic: The Use of Mini-Cog Screening Tool to Diagnose Alzheimer’s disease in the ElderlyDementia is a general diagnosis of cognitive disorders that effects memory, language, motor activity, and functions of daily living. The most common dementia is Alzheimer’s disease (AD) which effects more than 5.3 million individuals over the age of 60 (Centers for Disease Control and Prevention, 2015). The definitive diagnosis of AD is through autopsy, but a clinical diagnosis is made by an expert knowledgeable of the disease presentation and diagnostic testing.Case StudyA 72 y/o male patients comes in with his wife for an annual exam. His wife has made a comment about him loosing things lately and repeating himself. He states that it is just his “old-timers brain” and he is just teasing his wife. His exam, vital signs, and lab work are all within normal limits. The wife is concerned that more is going on and would like him tested for AD. You perform the mini-cog test to determine his baseline cognitive level.PICO Question Is the standardized mini-cog test superior at clinically diagnosing AD than other quick cognitive tests in the elderly population?Summary and Appraisal of Key EvidenceStudy A: Fage, Chan, Gill, Noel-Storr, Hermann, Smailagic, Nikolaou, Seitz, (2015) did a meta-analysis review of 3 studies to identify if the mini-cog questionnaire has validity to be used in screening and predicting a clinical diagnosis of AD in a community setting. Three studies were included totaling 1620 participants. One major strength to this review was the that the studies needed to clearly detail a diagnosis of dementia using either DSM IV-TR or NINCDS-ADRDA within four weeks of using the mini-cog. The QUADA-2 criteria was utilized to determine the sensitivity and specificity of the studies. The Mini-cog’s sensitivity for diagnosing AD was 0.99, 0.76, and 0.99 and the specificity included 0.93, 0.89, and 0.83 (Fage et al, 2015). Two of the studies had a high level of bias, due to being performed by the developers of the mini-cog. They may have overestimated the results. Study B: Milian, Leiherr, Straten, Müller, Leyhe, & Eschweiler (2012) identified 502 participants to determine if the mini-cog was more reliable at predicting dementia in the elderly than the Mini Mental State Exam (MMSE) or the Clock Drawing Test (CDT) from the non-cognitive impaired population. They concluded that the mini-cog had a discriminatory power of 86.8% compared to 72% with the MMSE and 78.1% of CDT (Milian et al., 2012) for specific dementias. Both the mini-cog and the MMSE had 100% specificity. The mini-cog showed the significantly superior for all ages and educational groups as compared to the CDT or MMSE. One weakness is that this was one retrospective study done to one specific population in a memory clinic. A strength was that all participants were evaluated before a formal diagnosis was made. Majority of the patients in the study were diagnosed with a form of dementia.Clinical Bottom LineThe mini-cog is a brief 3-5 minute tool that has proven validity in screening mild to moderate dementia. These studies did support mild ability to predict specific types of dementia, especially AD. This is a practical screening tool that could be used in both primary and community settings to determine need for further dementia testing. The mini-cog is definitely the best tool to use with any age or educational level.ReferenceCenters for Disease Control and Prevention (2013). Dementia/Alzheimer’s disease. . Retrieved from: , B., Chan, C., Gill, S., Noel-Storr, A., Hermann, N., Smailagic, N., Nikolaou, V., Seitz, D.P., (2015). Mini-cog for diagnosis of alzheimer’s disease dementia and other dementia’s within a community setting. Cochrane Database of Systematic Reviews. doi: 10.1002/14651858.CD010860.pub2.?Milian, M., Leiherr, A. M., Straten, G., Müller, S., Leyhe, T., & Eschweiler, G. W. (2012). The Mini-Cog versus the mini-mental state examination and the clock drawing test in daily clinical practice: screening value in a German Memory Clinic.?International Psychogeriatrics,?24(05), 766-774. ................
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