# Comparing Short Cognitive Screening Instruments in an Outreach Memory Clinic in Primary Care

## TL;DR

This study compares cognitive screening tools used in a pilot outreach memory clinic in primary care to improve access to mental healthcare.

## Contribution

The study introduces a new outreach model and evaluates the effectiveness of the Qmci screening tool in primary care settings.

## Key findings

- The Qmci screen showed excellent inter-rater reliability (r = 0.89) between general practice and the clinic.
- The Qmci was more accurate than the GPCOG in identifying cognitive impairment (AUC 0.95 vs. 0.80).
- The Qmci was as accurate as the MoCA but significantly shorter, making it more efficient for use in primary care.

## Abstract

Few studies have investigated the possibility of offering outreach from hospital-based memory clinic services to primary care. Such models could potentially improve access to specialised mental healthcare. We report on the reliability and validity of a pilot cognitive screening pathway in general practice (GP) in Ireland. Consecutive patients with memory complaints attending two primary care clinics were screened and diagnosed clinically by a physician-run memory clinic in GP. Follow-up in secondary care confirmed the diagnosis. Inter-rater reliability (IRR) and diagnostic validity of the Quick Mild Cognitive Impairment (Qmci) screen was compared to the Montreal Cognitive Assessment (MoCA) and General Practitioner Assessment of Cognition (GPCOG). In all, 63 patients, 31 with subjective memory complaints (SMC), 16 with mild cognitive impairment and 16 with dementia were screened. Their median age was 73 and 67% were female. The IRR of the Qmci screen between GP and clinic was excellent (r = 0.89). The Qmci was more accurate than the GPCOG in identifying cognitive impairment; the area under the curve (AUC) was 0.95 versus 0.80 (p = 0.008). The Qmci and MoCA had similar accuracy, with an AUC of 0.95 versus 0.91 (p = 0.117), respectively, but was significantly shorter (p < 0.001), suggesting it may be a useful instrument in this setting. Based on these results, a definitive study is now planned to examine the benefits and challenges of utilizing these instruments as part of establishing an outreach memory clinic service in primary care.