Development and validation of a dementia screening tool for primary care in Taiwan: Brain Health Test

Objectives
To develop a simple dementia screening tool to assist primary care physicians in identifying patients with cognitive impairment among subjects with memory complaints or at a high risk for dementia.
Design
The Brain Health Test (BHT) was developed by several experienced neurologists, psychiatrists, and clinical psychologists in the Taiwan Dementia Society. Validation of the BHT was conducted in the memory clinics of various levels of hospitals in Taiwan.
Participants
All dementia patients at the memory clinics who met the inclusion criteria of age greater or equal to 50 years were enrolled. Besides the BHT, the Mini-Mental State Examination and Clinical Dementia Rating were used to evaluate the cognition state of the patients and the severity of dementia.
Results
The BHT includes two parts: a risk evaluation and a cognitive test (BHT-cog). Self or informants reports of memory decline or needing help from others to manage money or medications were significantly associated with cognitive impairment. Among the risk factors evaluated in the BHT, a total risk score greater or equal to 8 was defined as a high risk for dementia. The total score for the finalized BHT-cog was 16. When the cutoff value for the BHT-cog was set to 10 for differentiating dementia and a normal mental state, the sensitivity was 91.5%, the specificity was 87.3%, the positive predictive value was 94.8%, and the negative predictive value was 80.1% The area under the receiver operating characteristic curve between dementia and healthy subjects was 0.958 (95% CI = 0.941–0.975).
Conclusions
The BHT is a simple tool that may be useful in primary care settings to identify high-risk patients to target for cognitive screening.

研究目标：研发一款简易的痴呆筛查工具，辅助全科医师在存在记忆主诉或痴呆高风险人群中识别认知障碍患者。
研究设计：大脑健康测试（Brain Health Test, BHT）由台湾痴呆症学会的多位资深神经科医师、精神科医师及临床心理学家联合研发，其效度验证工作在台湾各级医院的记忆门诊开展。
研究对象：本研究纳入所有就诊于记忆门诊、符合年龄≥50岁纳入标准的痴呆患者。除BHT外，同时采用简易精神状态检查量表（Mini-Mental State Examination, MMSE）与临床痴呆评定量表（Clinical Dementia Rating, CDR）对患者的认知状态及痴呆严重程度进行评估。
研究结果：BHT包含两大模块：风险评估模块与认知测试模块（BHT-cog）。受试者自述或知情人报告的记忆衰退、需他人协助管理财物或服药等情况，与认知障碍存在显著统计学关联。在BHT评估的各项风险因素中，总风险得分≥8分被定义为痴呆高风险。最终定型的BHT-cog总分为16分。当将BHT-cog区分痴呆与正常精神状态的截断值设为10分时，其灵敏度为91.5%，特异度为87.3%，阳性预测值为94.8%，阴性预测值为80.1%；痴呆患者与健康受试者的受试者工作特征曲线（receiver operating characteristic curve）下面积为0.958（95%置信区间：0.941~0.975）。
研究结论：BHT是一款简易筛查工具，可有效应用于全科医疗场景，用于识别需开展认知筛查的高风险人群。