Sam Creavin

Metabolic syndrome, diabetes, poor cognition, and dementia in the Caerphilly Prospective Study

We have examined whether metabolic syndrome is associated with intermediate risk of impaired cognition between people with and without diabetes. Men aged 45 to 59 years were identified from Caerphilly in South Wales, United Kingdom. Participation rate was 89% (41% of the original cohort) and 2,512 men were examined in phase one from July 1979 until September 1983. Follow-up examinations occurred at four intervals until 2004 when 1,225 men participated. Participants were categorized on the basis of their exposure to metabolic syndrome not diabetes (MSND) and diabetes (with or without metabolic syndrome) at each of the first three phases. Neuropsychological outcomes and clinical diagnosis of cognitive impairment not dementia (CIND) and dementia were assessed at phase five. The prevalence of MSND increased from 1% to 5% and for diabetes from 3% to 9% between phase one and phase three. 15% of participants had CIND and 8% dementia. People with diabetes, but not those with MSND, at phases one, two, or three had poorer cognition at phase five (adjusted β coefficient AH4 -4.3 95% CI -7.9, -0.7; phase two: -2.5 95% CI -4.7, -0.3; phase three: -2.3 95% CI -4.2, -0.5). The adjusted odds ratio (phase one) for diabetes and CIND was 4.0 (95% CI 1.4, 11.5) and dementia 0.61 (95% CI 0.07, 5.37). After adjustment, higher systolic blood pressure was the only component of the metabolic syndrome associated with worse cognitive outcomes. Diabetes in mid-life, but not MSND, is associated with impaired cognition and increased odds of CIND in later life.

Clinical history for diagnosis of dementia in men: Caerphilly Prospective Study

BACKGROUND Diagnosis of dementia often requires specialist referral and detailed, time-consuming assessments. AIM To investigate the utility of simple clinical items that non-specialist clinicians could use, in addition to routine practice, to diagnose all-cause dementia syndrome. DESIGN AND SETTING Cross-sectional diagnostic test accuracy study. Participants were identified from the electoral roll and general practice lists in Caerphilly and adjoining villages in South Wales, UK. METHOD Participants (1225 men aged 45-59 years) were screened for cognitive impairment using the Cambridge Cognitive Examination, CAMCOG, at phase 5 of the Caerphilly Prospective Study (CaPS). Index tests were a standardised clinical evaluation, neurological examination, and individual items on the Informant Questionnaire for Cognitive Disorders in the Elderly (IQCODE). RESULTS Two-hundred and five men who screened positive (68%) and 45 (4.8%) who screened negative were seen, with 59 diagnosed with dementia. The model comprising problems with personal finance and planning had an area under the curve (AUC) of 0.92 (95% confidence interval [CI] = 0.86 to 0.97), positive likelihood ratio (LR+) of 23.7 (95% CI = 5.88 to 95.6), negative likelihood ratio (LR-) of 0.41 (95% CI = 0.27 to 0.62). The best single item for ruling out was no problems learning to use new gadgets (LR- of 0.22, 95% CI = 0.11 to 0.43). CONCLUSION This study found that three simple questions have high utility for diagnosing dementia in men who are cognitively screened. If confirmed, this could lead to less burdensome assessment where clinical assessment suggests possible dementia.

Some like it hot: Medical student views on choosing the emotional level of a simulation

Medical Education 2011: 45: 354–361

Cognitive tests to help diagnose dementia in symptomatic people in primary care and the community

What brief cognitive test should a busy GP use when trying to assess someone who might have dementia? The menu of choices is long; one review found 11 options.1 The Cochrane Dementia and Cognitive Improvement Group (CDCIG) is conducting a series of reviews to evaluate the evidence of a range of tests for diagnosing dementia. To date, reviews have been published addressing the accuracy of two tests in primary care: the Informant Questionnaire for Cognitive Disorders in the Elderly (IQCODE) and the Mini Mental State Examination [MMSE]. Reviewers found only one study that investigated the use of the IQCODE in primary care,2 and six that investigated the use of the MMSE.3 A review of the Montreal Cognitive Assessment [MoCA] found no studies that evaluated the accuracy of the test in primary care.4 Reviews are underway for the Mini-Cog and AD-8 tests (see http://dta.cochrane.org/reviews-and-protocols-crg). The IQCODE is a structured informant questionnaire; 26-item and 16-item versions exist and scores range from 1 (no impairment) to 5 (more impairment).4 In the one study that investigated the use of the IQCODE at a threshold of 3.2 in primary care the sensitivity was 100% and specificity 76%, whereas at a threshold of 3.7 the sensitivity was 75% and specificity 98%.2 The MMSE is one of the oldest and therefore …

Why can't my child see 3D television?

A child encountering difficulty in watching three-dimensional (3D) stereoscopic displays could have an underlying ocular disorder. It is therefore valuable to understand the differential diagnoses and so conduct an appropriate clinical assessment to address concerns about poor 3D vision.

Clinical judgement by primary care physicians for the diagnosis of all‐cause dementia or cognitive impairment in symptomatic people

This is a protocol for a Cochrane Review (Diagnostic test accuracy). The objectives are as follows: To determine the accuracy of general practitioners’ overall gestalt (unaided) clinical judgement for diagnosing cognitive impairment and dementia in symptomatic people presenting to primary care. There is no comparator index test. To investigate the heterogeneity of test accuracy in the included studies.