Brain Health: Case Finding of Cognitive Impairment in Primary Care by Using a Risk Score and 2-Pronged Performance-based and Informant-based Assessment Approach.

impairment and Alzheimer disease.1 For China, it is reported that there were 9.19 million cases of any cognitive impairment in mainland China alone in 2010 and the numbers are expected to rise in the coming decades.2 Obviously, cognitive impairment will be a new epidemic in the future unless major public health policies and preventive measures target brain health. The International Association of Gerontology and Geriatrics (IAGG) Consensus article has put forward the need for screening and case finding of cognitive impairment.3 It is paramount that cognitive impairment should be screened for and recognized early. However, the lack of recognition of cognitive impairment by medical staff has been documented.4 The general underrecognition of dementia has serious consequences, such as not seeking medical help in a timely manner, inappropriate prevention, not planning for legal and financial affairs in advance, and insufficient training for caregivers. These factors create a negative consequence and significant financial burden on society. Also, it is upsetting for the individual and the individual’s family. Considering the huge population base, we have to say that dementia screening for every elderly person in China is a big challenge. With the emphasis that “screening instruments should take less than 3 to 7 minutes to administer,” the IAGG consensus article has recommended some screening tools, such as MiniCog, the 5 Words, Rapid Cognitive Screen (RCS), St Louis University Mental Status Examination (SLUMS), and Mini-Mental Status Exam (MMSE). In this sense, MiniCog, the 5Words, RCS, and SLUMS fulfill our requirements. In particular, SLUMS is a popular screening scale for cognitive impairment, which has been studied in the Chinese population in 2012.5 In this study, we compared consistency of the SLUMS with the Chinese version of Mini-Mental Status Examination (CMMSE) and the Beijing version of Montreal Cognitive Assessment (MoCA-B). The results showed that the scores of SLUMS are fairly consistent with MoCA-B and CMMSE in Chinese elderly. Spearman correlation coefficient between scores of the scales were 0.747 (SLUMS vs CMMSE, P < .001), 0.839 (SLUMS vs MoCA-B, P < .001), and 0.773 (CMMSE vs MoCA-B, P < .001). Financial input into senior care has increased from last year in China. By way of illustration, I will refer to the example of Chengdu city. Chengdu is the capital of Sichuan Province, covering a total land area of 12,400 square kilometers. Chengdu has direct jurisdiction over 10 districts, 4 county-level cities, and 5 counties. By the end of 2013, the population of Chengdu had reached 14.17 million. Up to now, the Chengdu Civil Affairs Bureau has set up hundreds of community health service settings for senior people. Each elderly person in the community will receive a quick screening for cognitive function by recalling 3 words. If there is any problem for recalling 3 words, further assessment of SLUMS should be carried out by trained assessors. In addition to cognitive assessments, we also evaluate other geriatric syndromes, including depression, pain, falls, and nutrition status. The elderly who received geriatric assessments at entry were followed up annually. In this way, we can track the elderly continually. These data will be further collected and the outcome will be released in the future.