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Attended With and Head-Turning Sign can be clinical markers of cognitive impairment in older adults

Published online by Cambridge University Press:  29 June 2017

Pinar Soysal ,
Cansu Usarel ,
Gul Ispirli  and
Ahmet Turan Isik
Pinar Soysal
Affiliation:
Kayseri Education and Research Hospital, Geriatric Center, Kayseri, Turkey
Cansu Usarel
Affiliation:
Unit for Aging Brain and Dementia, Department of Geriatric Medicine, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
Gul Ispirli
Affiliation:
Department of Internal Medicine, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
Ahmet Turan Isik*
Affiliation:
Unit for Aging Brain and Dementia, Department of Geriatric Medicine, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
*
Correspondence should be addressed to: Prof. Dr. Ahmet Turan Isik, Yaşlanan Beyin ve Demans Unitesi, Geriatri Bilim Dalı, Dokuz Eylul Universitesi Tıp Fakultesi, 35340 Balcova, Izmir, Turkey. Phone: + 90 232 412 43 41; Fax: + 90 232 412 43 49. Email: atisik@yahoo.com.
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Abstract

Background:

Comprehensive neurocognitive assessment may not be performed in clinical practice, as it takes too much time and requires special training. Development of easily applicable, time-saving, and cost effective screening methods has allowed identifying the individuals that require further evaluation. The aim of present study was to assess the diagnostic value of the Attended With (AW) and Head-Turning Sign (HTS) for screening cognitive impairment (CI).

Methods:

Comprehensive geriatric assessment was performed in 529 elderly outpatients, and the presence or absence of AW and HTS was investigated in them all.

Results:

Of the 529 patients, of whom the mean age was 75.67 ± 8.29 years, 126 patients were considered as CI (102 dementia, 24 mild CI). The patients with positive AW had significantly lower scores on Mini-Mental State Examination, Cognitive State Test, and Montreal Cognitive Assessment, and activities of daily living compared to AW (−) patients (p < 0.001). Similar significant findings were obtained in the patients with positive and negative HTS (p < 0.001). The sensitivity, specificity, positive predictive value, and negative predictive value of AW in detecting CI were 92%, 37%, 31.4%, and 93.7%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of HTS were 80%, 64%, 41.8%, and 91.5%, respectively. The area under the receiver-operating characteristics curve was 0.90 for AW and 0.82 for HTS.

Conclusion:

AW and HTS are fast, simple, effective, and sensitive methods for detecting CI. Therefore, they can be used for older adults attending the primary care settings with memory loss. Those with positive AW or HTS can be referred to the relevant centers for detailed cognitive assessment.

Keywords

Attended Withcognitive impairmentdementiaHead-Turning Signolder adults
Type
Paper of the Month
Information
International Psychogeriatrics , Volume 29 , Issue 11 , November 2017 , pp. 1763 - 1769
Copyright
Copyright © International Psychogeriatric Association 2017 

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References

Annoni, J.-M., Chouiter, L. and Démonet, J.-F. (2016). Age-related cognitive impairment: conceptual changes and diagnostic strategies. Revue Médicale Suisse, 12, 774–779.Google Scholar
Babacan-Yildiz, G. et al. (2013). COST: cognitive state test, a brief screening battery for Alzheimer disease in illiterate and literate patients. International Psychogeriatrics, 25, 403–412.Google Scholar
Babacan-Yildiz, G. et al. (2016). Validity and reliability studies of modified Mini-Mental State Examination (MMSE-E) for Turkish illiterate patients with diagnosis of Alzheimer disease. Turkish Journal of Psychiatry, 27, 41–46.Google Scholar
Fukui, T., Yamazaki, T. and Kinno, R. (2011). Can the ‘head-turning sign’ be a clinical marker of Alzheimer's disease? Dementia Geriatric Cognitive Disease Extra, 1, 310–317.Google Scholar
Gungen, C., Ertan, T., Eker, E., Yasar, R. and Engin, F. (2002). Reliability and validity of the standardized Mini-Mental State Examination in the diagnosis of mild dementia in Turkish population. Turkish Journal of Psychiatry 13, 273–281.Google Scholar
Gurvit, H. et al. (2008). The prevalence of dementia in an urban Turkish population. American Journal of Alzheimers Disesase and Other Dementias, 23, 67–76.Google Scholar
Heinik, J.-V.-A. (2010). Kral and the origins of benign senescent forgetfulness and mild cognitive impairment. International Psychogeriatrics, 22, 395–402.Google Scholar
Hildreth, K.-L. and Church, S. (2015). Evaluation and management of the elderly patient presenting with cognitive complaints. Medical Clinics of North America, 99, 311– 335.Google Scholar
Isik, A.-T. (2010). Late onset Alzheimer's disease in older people. Clinical Interventions in Aging, 11, 307–311.Google Scholar
Jonker, C., Geerlings, M.-I. and Schmand, B. (2000). Are memory complaints predictive for dementia? A review of clinical and population-based studies. International Journal of Geriatric Psychiatry, 5, 983–913.Google Scholar
Kaya, D., Isik, A.-T., Usarel, C., Soysal, P. and Ellidokuz, H. (2016). The Saint Louis University Mental Status Examination is better than the Mini-Mental State Examination to determine the cognitive impairment in Turkish elderly people. Journal of the American Medical Directors Association, 17, 370.e11–5.Google Scholar
Kukull, W.-A., Larson, E.-B., Teri, L., Bowen, J. and Mccormick, W. (1994). The Mini-Mental State Examination score and the clinical diagnosis of dementia. Journal of Clinical Epidemiology, 47, 1061–1077 Google Scholar
Larner, A.-J. (2005). “Who came with you?” A diagnostic observation in patients with memory problems? Journal of Neurology Neurosurgery Psychiatry, 76, 1739.CrossRefGoogle ScholarPubMed
Larner, A.-J. (2012). Head turning sign: pragmatic utility in clinical diagnosis of cognitive impairment. Journal of Neurology Neurosurgery Psychiatry, 83, 852–853.CrossRefGoogle ScholarPubMed
Larner, A.-J. (2014). Screening utility of the “attended alone” sign for subjective memory impairment. Alzheimer Disease Associated Disorders, 28, 364–365.Google Scholar
Lopez, O.-L. et al. (1994). Reliability of NINDS-AIREN clinical criteria for the diagnosis of vascular dementia. Neurology, 44, 1240–1245.Google Scholar
Martinez-Martin, P. et al. (2011). Dementia associated with Parkinson's disease: applying the movement disorder society task force criteria. Parkinsonism Related Disorders, 17, 621–624.Google Scholar
McKeith, I.-G. et al. (2005). Consortium on DLB. Diagnosis and management of dementia with Lewy bodies: third report of the DLB consortium. Neurology, 27, 65, 1863–1872.Google Scholar
McKhann, G. et al. (1984). Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group under the auspices of department of health and human services task force on Alzheimer's disease. Neurology, 34, 939–944.CrossRefGoogle ScholarPubMed
McKhann, G.-M., Knopman, D.-S. and Chertkow, H. (2011). The diagnosis of dementia due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dementia, 7, 263–269.Google Scholar
Pereira, (2016). A simple, rapid test called the Head Turning Sign (HTS) may help to assess the presence of Alzheimer's disease dementia. In Congress of the European Academy of Neurology (EAN).Google Scholar
Petersen, R.-C., Smith, G.-E., Waring, S.-C., Ivnik, R.-J., Kokmen, E. and Tangelos, E.-G. (1997). Aging, memory, and mild cognitive impairment. International Psychogeriatrics, 9, 65–69.Google Scholar
Ponds, R. W., Commissaris, K. J. and Jolles, J. (1997). Prevalence and covariates of subjective forgetfulness in a normal population in The Netherlands. The International Journal of Aging and Human Development, 45, 207–221.Google Scholar
Rascovsky, K. et al. (2011). Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia. Brain 134, 2456–2477.Google Scholar
Relkin, N., Marmarou, A., Klinge, P., Bergsneider, M. and Black, P.-M. (2005). Diagnosing idiopathic normal-pressure hydrocephalus. Neurosurgery, 57, 4–16.Google Scholar
Selekler, K., Cangöz, B. and Uluc, S. (2010). Montreal bilissel degerlendirme ölceginin hafif bilissel bozukluk ve alzheimer hastalarini ayirtedebilme gücünün incelenmesi. Turkish Journal of Geriatrics, 13, 166–171.Google Scholar
Soysal, P., Isik, A.-T., Buyukaydin, B. and Kazancioglu, R. (2014). A comparison of end-stage renal disease and Alzheimer's disease in the elderly through a comprehensive geriatric assessment. International Urology and Nephrology, 46, 1627–1632.CrossRefGoogle ScholarPubMed
Tariq, S.-H., Tumosa, N., Chibnall, J.-T., Perry, M.-H. and Morley, J.-E. (2006). Comparison of the Saint Louis University Mental Status Examination and the Mini-Mental State Examination for detecting dementia and mild neurocognitive disorder: a pilot study. American Journal of Geriatric Psychiatry, 14, 900–910.Google Scholar
Wimo, A. et al. (2017). The worldwide costs of dementia 2015 and comparisons with 2010. Alzheimers Dementia, 13, 1–7.Google Scholar