Dual-stage cognitive assessment: a two-stage screening for cognitive impairment in primary care

Background Aging population has led to an increased proportion of older adults and cognitively impaired. We designed a brief and flexible two-stage cognitive screening scale, the Dual-Stage Cognitive Assessment (DuCA), for cognitive screening in primary care settings. Method In total, 1,772 community-dwelling participants were recruited, including those with normal cognition (NC, n = 1,008), mild cognitive impairment (MCI, n = 633), and Alzheimer’s disease (AD, n = 131), and administered a neuropsychological test battery and the DuCA. To improve performance, the DuCA combines visual and auditory memory tests for an enhanced memory function test. Results The correlation coefficient between DuCA-part 1 and DuCA-total was 0.84 (P < 0.001). The correlation coefficients of DuCA-part 1 with Addenbrooke’s Cognitive Examination III (ACE-III) and Montreal Cognitive Assessment Basic (MoCA-B) were 0.66 (P < 0.001) and 0.85 (P < 0.001), respectively. The correlation coefficients of DuCA-total with ACE-III and MoCA-B were 0.78 (P < 0.001) and 0.83 (P < 0.001), respectively. DuCA-Part 1 showed a similar discrimination ability for MCI from NC (area under curve [AUC] = 0.87, 95%CI 0.848–0.883) as ACE III (AUC = 0.86, 95%CI 0.838–0.874) and MoCA-B (AUC = 0.85, 95%CI 0.830–0.868). DuCA-total had a higher AUC (0.93, 95%CI: 0.917–0.942). At different education levels, the AUC was 0.83–0.84 for DuCA-part 1, and 0.89–0.94 for DuCA-total. DuCA-part 1 and DuCA-total’s ability to discriminate AD from MCI was 0.84 and 0.93, respectively. Conclusion DuCA-Part 1 would aid rapid screening and supplemented with the second part for a complete assessment. DuCA is suited for large-scale cognitive screening in primary care, saving time and eliminating the need for extensively training assessors.