Objective: Recent therapeutic advances to delay the progression of dementia have renewed calls to improve early detection and management of individuals with dementia. However, few of the present neuropsychological tests can detect early dementia and are easily administered in the clinical setting. A new computerized neuropsychological interview and clinical examination, the Cognitive Assessment and Reference Diagnosis System (CARDS), was developed to incorporate in a single instrument all the information required to make an accurate clinical diagnosis of dementia, its subtype, depression, and delirium to present reference diagnoses just after completion of tests and to detect early dementia. We aim to make CARDS the norm in the community population.
Design: A nationwide population-based survey by cluster sampling method
Materials and Methods: A random cluster sample from 12 towns, aged 40 -90 (N=1,005) was selected. The CARDS-cog was administered to them. 6 aspects of cognition (amnesia, agnosia, aphasia, apraxia, dysexecution, and attention/calcultion) were tested. The CARDS-noncog was administered to gather information for the differential diagnosis of dementia in addition to clinical interview.
Results: Computer calculates expected scores of 6 cognitive domains for dementia diagnosis, 5% lower limits, as cutoff points, according to this study-derived regression equations (i.e. Expected score = a x Age + b x years of education + constant), to define caseness. The cutoff point of an individual is decided by age, sex, and educational attainment. The CARDS dianosis of dementia was given by predefined diagnostic algorithm, using information from the CARDS-cog and CARDS-noncog. Both sensitivity (0.97) and specificity (0.93) were execellent when the CARDS diagnosis is compared to clinical diagnosis.
Conclusion: We demonstrate that the CARDS is an execellent instrument not only for dementia diagnosis but also for evaluation of impaired cognitive domains. To the best of our knowledge, it is the first computerized instrument for clinic and population used to produce its own dementia diagnosis, according to DSM-IV, ICD-10, NINCDS-ADRDA, and NINDS-AIREN criteria just after completion of the tests.
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