Detection of dementia in primary care: comparison of the original and a modified Mini‐Cog Assessment with the Mini‐Mental State Examination

Background Dementia is considered widely under‐detected in primary care, and general practitioners (GPs) frequently ask for easy to use tools to assist in its early detection. Aim To determine the degree of correlation between the Mini‐Cog Assessment (Mini‐Cog) as performed by GPs and the Mini‐Mental State Examination (MMSE). Design of study This was a prospective study (2005, 2006) comparing two cognitive screening instruments. Setting Ten general practices in Austria, with patients with a hitherto undiagnosed suspicion of dementia seen consecutively. Method Sensitivity, specificity and positive and negative predictive values (PPVs and NPVs) of the Mini‐Cog (applying both a colour‐coded and the original rating method) were assessed for degree of correlation with the MMSE. In phase one GPs examined patients suspected of having dementia using the Mini‐Cog; in phase two a neurologist retested them applying the MMSE, a clock‐drawing test (CDT) and a routine clinical examination. A questionnaire on the practicability of the Mini‐Cog was answered by GPs. Results Of the 107 patients who participated 86 completed the whole study protocol. The Mini‐Cog, as performed by the ten GPs, displayed a sensitivity of 0.85 (95% CI: 0.71, 0.98), a specificity of 0.58 (95% CI: 0.46, 0.71), a PPV of 0.47 (95% CI: 0.33, 0.61) and an NPV of 0.90 (95% CI: 0.80, 0.99) as against the MMSE carried out by neurologists. The GPs judged the Mini‐Cog useful and time saving. Conclusion The Mini‐Cog has a high sensitivity and acceptable specificity in the general practice setting and has proved to be a practicable tool for the diagnosis of dementia in primary care.