To develop a screening system to triage clients with different levels of cognitive ability in Hong Kong primary care setting

Abstract Description

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Authors (including presenting author) :

Konishi R(1), Hui KY(1), Ma HY(1),Ma WL(1), Tsang YN(1), Chan SL(2), Li YC(2)

Affiliation :

1 Department of Occupational Therapy, Queen Elizabeth Hospital
2 Department of Family Medicine and General Outpatient Clinic, Queen Elizabeth Hospital

Introduction :

In view of the increasing population being diagnosed with cognitive impairments in Hong Kong (Prevalence rate of 6.8% for dementia at the age above 65), an efficient screening system is needed for the prompt triage of patients with different needs. Hong Kong Montreal Cognitive Assessment (HK-MoCA) is a commonly used tool. However, it could be too challenging for those with dementia features, resulting in anxiety or frustration. The Abbreviated Mental Test (AMT) is another cognitive assessment but it could not detect patients with mild cognitive impairment due to ceiling effect.

Objectives :

The objective of present study is to develop a screening system to make a balance between effective identification of patients with cognitive impairment and creating an optimal test-taking situation for clients.

Methodology :

A retrospective study was conducted in the Occupational Therapy Unit of Enhancement of Public Primary Care Services (EPPS) in Yau Ma Tei Jockey Club Clinic for clients who had subjective report of declined cognitive functions. The clients were referred from Kowloon Central Cluster Family Medicine and General Out-patient Clinic for cognitive assessment during 1 April 2017 to 31 March 2018. Subjects were recruited by convenient sampling and were aged 65 or above. Functional Assessment Staging Test was employed based on clients’ ADL and IADL performances. HK-MoCA and AMT were also administrated to each client by registered occupational therapist. To assess the relationship between HK-MoCA and AMT, Pearson correlation coefficient (r) was used.

Result & Outcome :

Data of 395 clients (Mean age of 78.8 with 63% female) was analyzed. There was a high positive correlation between the total scores of HK-MoCA and AMT (r=0.838; p<0.01). Given the high positive correlation between the total scores of HK-MoCA and AMT, clients who scored below the cut off score of 6 in AMT are likely to fall into Major Neurocognitive Disorder (as classified by HK-MoCA). Therefore, it is suggested that after applying Functional Assessment Staging Test with reference to clients’ ADL and IADL abilities, for those with dementia features, AMT instead of HK-MoCA could probably be the first line of screening to avoid triggering of clients’ unnecessary anxiety or frustration. On the other hand, HK-MoCA should be administrated to clients without obvious dementia features to prevent ceiling effect.