Using temporal orientation, category fluency, and word recall for detecting cognitive impairment: the 10-point cognitive screener (10-CS) Daniel Apolinario 1 , Daniel Gomes Lichtenthaler 1 , Regina Miksian Magaldi 1 , Aline Thomaz Soares 1 , Alexandre Leopold Busse 1 , Jose Renato das Gracas Amaral 1 , Wilson Jacob-Filho 1 and Sonia Maria Dozzi Brucki 2 1 Division of Geriatrics, Department of Internal Medicine, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil 2 Division of Behavioral and Cognitive Neurology, Department of Neurology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil Correspondence to: Daniel Apolinario, E-mail: daniel.apolinario@usp.br Objectives: A screening strategy composed of three-item temporal orientation and three-word recall has been increasingly used for detecting cognitive impairment. However, the intervening task administered between presentation and recall has varied. We evaluated six brief tasks that could be useful as interven- ing distractors and possibly provide incremental accuracy: serial subtraction, clock drawing, category fluency, letter fluency, timed visual detection, and digits backwards. Methods: Older adults (n = 230) consecutively referred for suspected cognitive impairment underwent a comprehensive assessment for gold-standard diagnosis, of whom 56 (24%) presented cognitive impairment not dementia and 68 (30%) presented dementia. Among those with demen- tia, 87% presented very mild or mild stages (Clinical Dementia Rating 0.5 or 1). The incremental value of each candidate intervening task in a model already containing orientation and word recall was assessed. Results: Category fluency (animal naming) presented the highest incremental value among the six can- didate intervening tasks. Reclassification analyses revealed a net gain of 12% among cognitively im- paired and 17% among normal participants. A four-point scaled score of the animal naming task was added to three-item temporal orientation and three-word recall to compose the 10-point Cognitive Screener. The education-adjusted 10-point Cognitive Screener outperformed the longer Mini-Mental State Examination for detecting both cognitive impairment (area under the curve 0.85 vs 0.77; p = 0.027) and dementia (area under the curve 0.90 vs 0.83; p = 0.015). Conclusions: Based on empirical data, we have developed a brief and easy-to-use screening strategy with higher accuracy and some practical advantages compared with commonly used tools. Copyright # 2015 John Wiley & Sons, Ltd. Key words: orientation; memory; verbal fluency; dementia; mild cognitive impairment; screening History: Received 9 October 2014; Accepted 17 February 2015; Published online in Wiley Online Library (wileyonlinelibrary. com) DOI: 10.1002/gps.4282 Introduction Dementia is highly unrecognized in medical settings, where between 42% and 67% of the affected individ- uals are not properly diagnosed (O’Connor et al., 1988; Jacinto et al., 2011). Rates of unrecognized de- mentia are even higher in early stages. Physicians fail to make diagnosis in up to 91% of the patients with mild dementia (Valcour et al., 2000). Subjective factors affect the recognition of cogni- tive impairment and previous studies have reported that objective tests can identify impaired subjects more accurately than physicians in regular clinical en- counters (Borson et al., 2006). Accordingly, recent Copyright # 2015 John Wiley & Sons, Ltd. Int J Geriatr Psychiatry 2015 RESEARCH ARTICLE