Study Evaluates Screening Test for Alzheimer's Disease

(50th Annual Scientific Assembly of the American Academy of Family Physicians) The Seven-Minute Screen, a quickly administered neurocognitive screening battery for Alzheimer's disease, is an effective tool to use in identifying patients with probable Alzheimer's disease in a primary care practice. This is the conclusion of a study of 137 successive patients older than 60 years in a primary care practice who were evaluated with a history, brief mental status testing and the Seven-Minute Screen. Of the 137 patients, 124 had a negative result (i.e., low probability of dementia) on the Seven-Minute Screen and 13 patients screened positive (i.e., high probability of dementia). A random sample of 26 patients with a low probability of dementia underwent a history, a physical examination and a comprehensive neuropsychologic evaluation. Only one of these patients demonstrated mild cognitive impairment; the others had no evidence of Alzheimer's disease or other dementia. Of the 13 patients with a positive screen, 11 agreed to return for further evaluation. Ten of the 11 patients were subsequently diagnosed with probable Alzheimer's disease. The investigators note that the Seven-Minute Screen was reported to have a sensitivity of more than 90 percent and a specificity of more than 90 percent in a report in the Archives of Neurology (1998;55:349-55).—paul r. solomon, ph.d., et al., Williams College/Bronfman Science Center, Williamstown, Mass.

Personal Contact Can Improve Mammogram Compliance

(American Academy of Family Physicians) Results of a study of 299 women in a family practice center indicate that sending a letter and making a telephone call to patients to remind them to have a mammogram significantly improves the screening compliance rate. The women in the study were older than 50 years and were divided into three groups. A control group of 110 women received no intervention. The second group of 102 women received a reminder letter from the radiology department. The third group (87 women) received a reminder letter followed by a telephone call eight weeks later if the women had not had a mammogram. All three groups of women were studied for a 14-week period. Thirty-three percent of the women in the control group obtained mammograms, compared with 37 percent of the women in the letter-only group and 57 percent of the women who received both the letter and the telephone call. The investigators note that the cost-effectiveness of the additional intervention needs further evaluation.—anita bodiya, m.d., and donna vorias, m.d., et al., Southfield, Mich.

Postpartum Depression May Be Underdiagnosed

(American Academy of Family Physicians) A prospective study of 685 women giving birth in Olmsted County, Minnesota, from July 28, 1997, to March 28, 1998, showed that the prevalence of postpartum depression was 11.5 percent. A previous retrospective chart review revealed a 3.7 percent prevalence of documented postpartum depression in a sample of 403 women giving birth in Olmsted County in 1993. To determine the prevalence of postpartum depression in the 1997-98 study, the Edinburgh Postnatal Depression Scale (EPDS) was administered at the first regularly scheduled postpartum visit. Seventy-nine of the women in the 1997-98 study had scores of 12 or above on the EPDS, indicating a high probability of depression. Eleven of the women reported having suicidal ideation “sometimes” or “quite often” during the week before the test was administered. The investigators believe that the significant difference in the incidence of postpartum depression as documented in the medical records of women in 1993 and the prospective prevalence of postpartum depression found in the 1997-98 study suggests that postpartum depression may have been underdiagnosed in this community. They report that the 11.5 percent prevalence is sufficient to warrant appropriate mass screening of the community.––anna m. georgiopoulos and tonya l. bryan, et al., Mayo Medical School/Mayo Clinic, Rochester, Minn.

Attention-Deficit Hyperactivity Disorder May Be Overdiagnosed

(American Academy of Family Physicians) Before attention-deficit hyperactivity disorder (ADHD) is assumed to be the diagnosis in children and adolescents who have academic and behavioral problems, a comprehensive evaluation of the child should be performed, according to a study of 54 children and adolescents in a primary care setting referred by parents and teachers over a 15-month period. Age, racial background and socioeconomic background of the children varied, but all of the children were from a rural community. The children underwent extensive evaluation. Eighty percent of the subjects had a diagnosis other than ADHD. The number and percentage of children in each diagnostic category were as follows: cognitive academic learning (12 children, 22.2 percent), ADHD (11 children, 20.4 percent), not disabled (10 children, 18.5 percent), internalizing (seven children, 13.0 percent), communication (five children, 9.3 percent), family psychosocial (five children, 9.3 percent) and oppositional conduct (four children, 7.4 percent). The investigators believe the study results show the necessity of identifying the influence of different variables in a patient and of the importance of evaluating these factors before making a diagnosis.—louis h. mccormick, m.d., Franklin, La.

Use of a Quality Indicator Flow Sheet Improves Care of Diabetic Patients

(American Academy of Family Physicians) The care of elderly patients with type 2 diabetes (formerly known as non–insulin-dependent diabetes mellitus, or NIDDM) can be improved in family practices with the use of a quality indicator flow sheet in the charts of these patients. This was the conclusion of a study of patients with type 2 diabetes in a family practice group of 17 physicians. The quality indicators in the study were (1) measurement of hemoglobin A_1C levels every six months, (2) an annual urine protein dipstick measurement, (3) a microalbumin test if the dipstick test is negative, (4) annual retinoscopy, (5) referral to an ophthalmologist if retinoscopy is abnormal, (6) a foot examination every six months, and (7) home blood glucose monitoring. The flow sheet was included in the charts of 114 patients in a random sample of patients 65 years of age or older with type 2 diabetes. The postintervention sample included 109 patients with type 2 diabetes who were seen by the practice after implementation of the flow sheet. Postintervention data in six of the seven indicators were better when compared with baseline data. The investigators believe that the flow sheet helped the practice by serving as a documentation tool, a reminder system and an organizer of key aspects of care for patients with diabetes, increasing the likelihood that the identified quality indicators would be met.—gary ruoff, m.d., and lynn s. gray, m.d., Michigan State University College of Medicine, Lansing.