Performance of cognitive screening tools in detecting possible dementia among older males in custody in Canada: a pilot study

BACKGROUND: Older individuals represent a growing demographic in correctional institutions worldwide, many of whom are living with complex health and social needs. One area of concern is that older people in custody are at increased risk of developing, or are currently living with, neurocognitive issues such as dementia. This pilot study examined the preliminary diagnostic performance of several cognitive screening tools for detecting suspected cases of dementia when compared with a formal diagnostic assessment among older people in custody at a multi-level forensic psychiatric treatment centre in Saskatchewan, Canada. RESULTS: Data collection included administering cognitive screening tools to older people in custody (n = 28) and a formal diagnostic assessment for dementia by a geriatrician (n = 18). Findings revealed that (a) cognitive screening tools varied in the identification of possible dementia, with point estimates ranging from 21% (Canadian Indigenous Cognitive Assessment; CICA) to 43% (Community Screening Instrument for Dementia; CSI 'D'), whereas 33% of participants were screened positive for cognitive impairment (Mini-Mental State Exam; MMSE); (b) approximately 39% were diagnosed with dementia and 17% with mild cognitive impairment; and, (c) certain screening tools (CICA and MMSE) perform better in classifying cases of dementia. CONCLUSIONS: Preliminary evidence suggests variability in the diagnostic performance of the assessed cognitive screening tools. The CICA and MMSE show promise in discriminating older males in custody in a forensic psychiatric setting with dementia from those without.