Un site du Démegraph est maintenant disponible en français sur le Web.

The DemeGraph is an aid to assessing patients for dementia by combining standard cognitive testing with a formal means of assessing an informant's view of changes in the patient's memory and cognitive functioning.

Administer the Mini-Mental State Examination (MMSE; Folstein et al., 1975) according to the instructions given by the test authors.

Have an informant who knows the subject well complete the Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE; Jorm, 1994).

Calculate test scores and plot them on the DemeGraph template:

Patients whose score profile falls above the diagonal line (the unshaded portion of the graph) are likely to meet criteria for DSM-IV Dementia. Patients who fall below the line (the shaded part of the graph) are unlikely to meet the criteria for this disorder. On the above template, one patient, marked with a has an MMSE score of 27 and an IQCODE score of 4.5 (halfway between 'A bit worse' and 'Much worse' on the IQCODE scale). This score combination lies in the unshaded part of the graph and so DemeGraph classifies them as likely to be a case of dementia. Another patient marked with a has an MMSE score of 23.5 and an IQCODE score of 3.1 (just above 'Not much Change' on the IQCODE scale). This person is classified by the DemeGraph as unlikely to meet criteria for a diagnosis of dementia.

Folstein, M., Folstein, S., & McHugh, P. R. (1975). Mini-Mental State: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189-198.
Jorm, A. F. (1994). A short form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): Development and cross-validation. Psychological Medicine, 24, 145-153.

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The DemeGraph template is offered for screening purposes only. Diagnosis of dementia requires appropriate investigation by suitably qualified professionals.

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The research project that produced the Demegraph was presented at the 1997 World Congress of Gerontology in Adelaide, Australia in a paper entitled "Combining cognitive testing and informant report to increase accuracy in screening for dementia". This paper will appear in the American Journal of Psychiatry in November 1998. Here are some details of the project

While cognitive testing is the mainstay in the assessment of dementia, recent research has demonstrated that methods of assessment based on informant report show comparable levels of performance in both clinical and epidemiological applications. The aim of this study was to determine whether the combined use of these methods could improve accuracy in screening for the diagnosis of dementia.

Subjects were a series of 106 patients referred to the University hospital system in Geneva, Switzerland for assessment. Cognitive state was assessed using the Mini-Mental State Examination (MMSE). The 16-item short form of the Informant Questionnaire for COgnitive Decline in the Elderly (IQCODE) was completed by a relative of each patient. Diagnosis of dementia according to DSM-IV criteria was made by a psychiatrist.

Logistic regression was used to demonstrate that the combination of both the MMSE and the IQCODE resulted in more accurate prediction of casedness than either test alone. The performance of an optimal linear combination of scores on the two tests as a screen for dementia was investigated using Receiver Operating Characteristic analysis. Attributes of a number of methods of undertaking this combination that could easily be put into practice in clinical settings were also investigated.

While replication in samples having differing prevalence of cases of dementia would be desirable, this study shows that informant report can be formally incorporated into assessment for dementia in such a way as to increase the accuracy of detection of cases and noncases.

We hope you find this tool useful. We are interested in comments you have about the Demegraph or this web site. Please use the form below to send your comments or email us.

Assoc. Prof. Andrew Mackinnon is Head of the Biostatistics and Psychometrics Unit at the Mental Health Research Institute. He is also a member of the Department of Psychological Medicine at Monash University.	Dr Reinhild Mulligan is director of the Consultation Mémoire, Hôpitaux Universitaires de Genève. She is a member of the Department of Psychiatry of the University of Geneva.
Phone +61 (0)3 388 1633 Fax +61 (0)3 9387 5061 Mailing Address: Mental Health Research Institute, Locked Bag 11 Parkville Vic 3052 Australia	Phone + 41 22 718 45 92 Fax + 41 22 718 45 99 Mailing Address Consultation Mémoire, 6, rue de XXXIst Décembre CH-1207, Geneva Switzerland

If you are interested in psychogeriatric assessment, you may find our Psychogeriatric Assessment Scales home page of interest. The Psychogeriatric Assessment Scales provide a more comprehensive assessment of cognitive status and depressed mood in older persons. The User's Guide and all necessary materials are available from the PAS web site.

The Demegraph Home Page has been accessed times since 1 June 1998.

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