Objective: The General Practitioner Assessment of Cognition (GPCOG) is a new screening test for dementia designed for general practice (H. Brodaty et al,. JAGS 2002; 50:530-534). Our aim is to evaluate whether the Italian version of GPCOG (GPCOG-IT) maintains the psychometric characteristics of the original version.
Design: The GPCOG consists of: 1) patient section based on 9 cognitive items; 2) informant section covering 6 clinical relevant items filled by caregiver’s appraisals. The validity of the measure of the GPCOG-IT was assessed with the criterion standard of diagnoses of dementia derived from DSMIV.
Settings: Dementia Assessment Units, as promoted by "Progetto Cronos" a nationwide program implemented by National Department of Health for the screening, diagnosis and treatment of Alzheimer's disease.
Participants: The GPCOG-IT was administered to 102 community-dwelling patients aged 60 to 89 (mean age 74.4 ± 6.3 years) with Clinical Dementia Rating total score 0-1(CDR-T). 52% were male and 68.6% had completed only elementary school.
Measurements: a) Cognitive domain: GPCOG-IT Patient (score 0-9) and Informant section (score 0-6) (higher is better for both subscales); MMSE, CAMCOG, ADAS-Cog ; b) Affect: 15-item Geriatric Depression Scale (GDS); c) Function and clinical staging: score = Total (CDR-T) and Sum of Boxes (CDR-SB).
Results: There were significant differences on the GPCOG-IT Patient section between patients who were classed as no (CDR-T = 0), questionable (CDR-T = 0.5) or mild dementia (CDR-T = 1) (Manova: Wilk’s < ,005) and this could not be accounted for by demographic or depressive differences. The GPCOG-IT Patient subscale was highly and significantly correlated with all cognitive (Pearson’s correlations: MMSE=.79, CAMCOG=.84, ADAS-Cog= -.83) and functional measures (CDR-SB= -.70). Considering as factor the patients, subdivided according to the 3 categories reported in the original GPCOG study (0-4= impaired; 5-8= borderline; 9= normal), a Manova revealed global significant difference for the cognitive and functional measures (Wilk’s < ,005). Finally, when the GPCOG-IT Informant classes (0-3 = pathological; 4-6 = healthy) were applied to the borderline patients, 2 groups with appreciably different cognitive performance were identified (Anova= CAMCOG: .001; ADAS-Cog: .002; MMSE: .0005). The sensitivity of the first step GPCOG-IT, patient cognitive testing, against the gold standard of DSM IV diagnosis was 97%; its specificity was 54%. Application of the second step informant subscale to borderline patients, increased the specificity to 71%. Time for completion of the GPCOG-IT (Patient mean = 3,8 minutes ± 1,3; Informant = 1.8 minutes ± 0,8) was less than for other cognitive scales.
Conclusion: Preliminary data suggest that the two-stage method of administering the GPCOG-IT (cognitive testing followed by informant questions if required) is a valid, efficient, and quick instrument for dementia screening.
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