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Dementia Screening

Can a Second Administration Reduce the Number of False Positives?

Received January 3, 2002; revised March 27, June 29, 2002; accepted July 12, 2002. From the Hawaii State Hospital (DF), John A. Burns School of Medicine, Department of Psychiatry (DF,EH,KM,HP,GWR,LW), Kuakini Medical Center (KM,HP), Department of Veteran Affairs, Honolulu (GWR), and Pacific Health Research Institute (LW). Address correspondence to Dr. Fujii, Hawaii State Hospital, 45-710 Keaahala Road, Kaneohe, Hawaii 96744. e-mail: defujii{at}hsh.health.state.hi.us

Objective: Early diagnosis of dementia is important for medical treatment and quality-of-life interventions. The authors examine whether administering a second cognitive screening after a poor initial score can improve the accuracy of diagnosis. Of particular interest is reducing false positives that may generate an unnecessary referral for a dementia work-up. Methods: A group of 389 Japanese men from the Honolulu-Asia Aging Study were administered the Cognitive Assessment Screening Instrument (CASI) twice within a 2-month period. A small sample received a follow-up CASI 3 years later. Results: Administration of a second CASI reduced the false-positive rate by 16.1% in the total sample and 20.2% in those suspected of having mild dementia. The negative predictive value for the second administration was 80% for the entire sample and 82.6% for those suspected of having mild dementia. Conclusion: Administration of a second cognitive screening in patients initially scoring in the dementia range can significantly reduce the number of false positives for dementia. This technique may be useful to managed-care companies who aim to reduce unnecessary costs in medical care.

Key Words: Dementia Screening • Alzheimer Disease

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