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Background: Heightened public awareness about Alzheimer's disease and dementia increases the need for at‐home cognitive self‐testing. We offered Cognitive Online Self‐Test Amsterdam (COST‐A) to independent groups of cognitively normal adults and investigated the robustness of a norm‐score formula and cutoff. Methods: Three thousand eighty‐eight participants (mean age ± standard deviation = 61 ± 12 years, 70% female) completed COST‐A and evaluated it. Demographically adjusted norm scores were the difference between expected COST‐A scores, based on age, gender, and education, and actual scores. We applied the resulting norm‐score formula to two independent cohorts. Results: Participants evaluated COST‐A to be of adequate difficulty and duration. Our norm‐score formula was shown to be robust: ≈8% of participants in two cognitively normal cohorts had abnormal scores. A cutoff of ‐1.5 standard deviations proved optimal for distinguishing normal from impaired cognition. Conclusion: With robust norm scores, COST‐A is a promising new tool for research and clinical practice, providing low cost and minimally invasive remote assessment of cognitive functioning. [ABSTRACT FROM AUTHOR]

Background: The Montgomery Åsberg Depression Rating Scale (MADRS) is a frequently used observer-rated depression scale. In the present study, a telephonic rating was compared with a face-to-face rating in 66 primary care patients with minor or mild-major depression. The aim of the present study was to assess the validity of the administration by telephone. Additional objective was to study the validity of the first item, 'apparent sadness', the only item purely based on observation. Methods: The present study was a validity study. During an in-person interview at the patient's home a trained interviewer administered the MADRS. A few days later the MADRS was administered again, but now by telephone and by a different interviewer. The validity of the telephone rating was calculated through the appropriate intraclass correlation coefficient (ICC). Results: Mean total score on the in-person administration was 24.0 (SD = 11.1), and on the telephone administration 23.5 (SD = 10.4). The ICC for the full scale was 0.65. Homogeneity analysis showed that the observation item 'apparent sadness' fitted well into the scale. Conclusion: The full MADRS, including the observation item 'apparent sadness', can be administered reliably by telephone. [ABSTRACT FROM AUTHOR]

Background: The objective of this article is to describe the design of an evaluation of the cost-effectiveness of systematic home visits by nurses to frail elderly primary care patients. Pilot objectives were: 1. To determine the feasibility of postal multidimensional frailty screening instruments; 2. to identify the need for home visits to elderly. Methods: Main study: The main study concerns a randomized controlled in primary care practice (PCP) with 18 months follow-up and blinded PCPs. Frail persons aged 75 years or older and living at home but neither terminally ill nor demented from 33 PCPs were eligible. Trained community nurses (1) visit patients at home and assess the care needs with the esident Assessment Instrument-Home Care, a multidimensional computerized geriatric ssessment instrument, enabling direct identification of problem areas; (2) determine the are priorities together with the patient; (3) design and execute interventions according to protocols; (4) and visit patients at least five times during a year in order to execute and monitor the care-plan. Controls receive usual care. Outcome measures are Quality of life, and Quality Adjusted Life Years; time to nursing home admission; mortality; hospital admissions; health care utilization. Pilot 1: Three brief postal multidimensional screening measures to identify frail health among elderly persons were tested on percentage complete item response (selected after a literature search): 1) Vulnerable Elders Screen, 2) Strawbridge's frailty screen, and 3) COOP-WONCA charts. Pilot 2: Three nurses visited elderly frail patients as identified by PCPs in a health center of 5400 patients and used an assessment protocol to identify psychosocial and medical problems. The needs and experiences of all participants were gathered by semi-structured interviews. Discussion: The design holds several unique elements such as early identification of frail persons combined with case-management by nurses. From two pilots we learned that of three potential postal frailty measures, the COOP-WONCA charts were completed best by elderly and that preventive home visits by nurses were positively evaluated to have potential for quality of care improvement. [ABSTRACT FROM AUTHOR]