Questions
Administration
1. What is the purpose of the GPCOG?
2. How does the online GPCOG work?
3. How is the GPCOG scored?
4. Are there any certain rules/things to keep in mind when administering the GPCOG?
5. Do I have to complete the informant interview?
6. I rather do a paper-and-pencil test with my patients. Are the web-based GPCOG and the paper-and-pencil test the same?
7. Do I have to administer the informant interview the same day?
8. Can I enter the answers while the patient is still in my practice?
9. Do I get a print-out of the test results for my records?
10. Can I save the results onto my computer?
11. How long does it take to administer the GPCOG?
12. Is there a training video available?
13. Where can I find additional information?
14. What do I do if my patient is cognitive impaired?
Background
1. What is the purpose of this website?
2. Who developed the GPCOG?
3. Who funded the development of the GPCOG?
4. Do you have any commercial interests? Are any pharmaceutical companies involved in this project?
5. Is the GPCOG currently used in research?
6. Is the GPCOG a recommended screening tool for dementia?
Copyright
1. Who can download or use the GPCOG?
2. What are the costs for using the GPCOG?
3. Can I reprint the GPCOG?
4. I am using the GPCOG for research purposes. Do I have to acknowledge the authors of the GPCOG?
5. I am interested in translating the GPCOG into a certain language. Can I do so? Who do I have to contact?
Answers
Administration
1. What is the purpose of the GPCOG?
The GPCOG is a screening instrument rather than a diagnostic test. It is very brief but at the same time very sensitive to detect cognitive impairment. However, this does not mean that the GPCOG is perfect in detecting cases. It might miss cases (false negatives) or misclassify someone as cognitive impaired even though they are fine (false positives). The chances to do so are very little though and depend on the prevalence of cognitive impairment in the given population. For more information about this click .
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2. How does the online GPCOG work?
Click the "Start Test" button on the homepage. The following page reminds you of some basic instructions as to how to administer the GPCOG. Hit the "Start Test" or "Proceed to Question 1" button after you have read the instructions. In the following, each GPCOG question will be presented to you on a separate screen. Read out each question (bold text) as it is presented on the screen and mark the patient's responses by ticking the appropriate boxes.
After the last question was answered, the website will provide you with some feedback on the patient's total score and whether further steps are required or not. If you are prompted to conduct the informant interview you can either do it straight away by clicking on the provided link or complete it at a later stage. Remember to print out the results of the patient assessment if you decide to conduct the informant interview at a later stage as the website will not save your data (for instructions on how to do so please see here or here). To start the informant interview at a later stage just access it through the homepage or click here and read out the questions as they are presented on the screen and mark the responses accordingly. Once you have pressed the "Next" button the website will generate the score for this section and tell you what to do next.
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3. How is the GPCOG scored?
Scoring the patient assessment:
Each correct answer scores one point. To get a total, add the points for items answered correctly. That gives you a score between 0 and 9. A score of 9 indicates no significant cognitive impairment and further testing is not required (you may ask the patient to come in for a follow-up assessment in 12 months). If the patient scores between 5 and 8 out of 9, more information is needed. You should conduct the informant interview. The web-based GPCOG will prompt you to do so. A score of 0 to 4 out of 9 indicates cognitive impairment. Standard investigations should be conducted. Please find a list of recommended standard investigations here.
Scoring the informant interview:
For the informant interview, "yes"-responses indicate impairment; hence each question that was not answered "yes" (ie "no", "don't know" or "N/A") scores one point. To get a total score, add the number of items answered "no", "don't know" or "N/A". Then you get a score between 0 and 6 (higher scores indicate less impairment). If the score is 0 to 3, cognitive impairment is indicated and standard investigations should be conducted. Please find a list of recommended standard investigations here.
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4. Are there any certain rules/things to keep in mind when administering the GPCOG?
In general, the administration of the GPCOG is very simple. However, there are some basic things to bear in mind:
- If you are administering the GPCOG for the first time it might be a good idea to familiarise yourself with both the paper-and-pencil and the web-based GPCOG prior to first administration to allow for a smooth flow of the test. There is a training video available for you to watch online if you wish. Just click here.
- Make sure, patients are wearing their glasses/hearing aids if applicable
- Unless specified, each question should only be asked once.
- Read out each question as it is presented on the screen (bold text) or on the paper version of the GPCOG.
- Speak clearly and slowly.
- Keep disturbances and interruptions at a minimum. For instance have a "Please do not disturb" sign up on your door.
- When interviewing a carer/informant, make sure that you only score patient difficulties that have been a change compared to a few years ago.
5. Do I have to complete the informant interview?
If the patient scores 5 to 8 out of 9 in the cognitive assessment, you do have to complete the informant interview to obtain more information about the patient's abilities. The web-based GPCOG will prompt you automatically to conduct the informant interview. Please note that you do not have to complete the informant interview the same day though. You can also complete it over the phone if that is more convenient.
If the patient scores 9 or 0 to 4 out of 9 the informant interview is not mandatory. However, you may conduct it if you wish. Top
6. I rather do a paper-and-pencil test with my patients. Are the web-based GPCOG and the paper-and-pencil test the same?
The web-based GPCOG and the paper-and-pencil GPCOG ask the same questions hence the information collected is the same. The only difference is that the web-based GPCOG does the scoring for you whereas you have to score the paper-and-pencil test yourself. You will find scoring instructions printed on the paper-and-pencil forms or if you click here. Top
7. Do I have to administer the informant interview the same day?
You do not have to administer the informant interview the same day as the patient assessment. However, we recommend that you conduct both parts in a timely manner (i.e. not weeks apart as the patient's performance might change over time). Top
8. Can I enter the answers while the patient is still in my practice?
Certainly you can. The web-based GPCOG is set up so that you can enter all data while the patient is there and click the "next" button after each question. The web-algorithm will automatically score the test for you and give you feedback according to your patient's total score. That means that the website will only prompt you to conduct the informant interview or to conduct standard investigations if it is applicable and appropriate for this particular patient. Please note that at the end of the test you will be able to print out a test summary with all of your patient's answers including the total score and further feedback that was presented to you on the screen. Top
9. Do I get a print-out of the test results for my records?
Yes, you do. If you have entered all your patient's responses the website will immediately give feedback on your patient's score and whether further steps are required. On that page you will also find a link to "print out a summary of the test results for your records". If you click on the link provided there you will be asked to enter some patient data. Please note that this information is for your records only. It will not be saved on our servers. You may also wish to just type in patient's initials which would be fine. The print-out summary will even be generated if you leave these boxes empty. Click "next" and you will get a printer friendly version of your patient's test results. To print this page simply select "File" from your menu and then "Print" or press Ctrl+P.
As you can conduct patient and informant parts on separate days you can also print out patient and informant results separately (this is recommended). Each time you have completed an assessment you will be given the chance to print out the results. However, this information will be lost once you close your web browser window or you continue entering data for a new patient. So if you wish to print out the results make sure you do it straight after each assessment as the website cannot save any patient results for you. Top
10. Can I save the results onto my computer?
You can save your patient's results by using the print-out option (see above).
To do so, just click on the link "print out a summary of test results for your records" on the feedback page (this page comes up automatically once you have completed the patient and/or informant assessment). The website will now ask you for some patient related data. Please note this is for your records only. These data will NOT be saved on our servers. If you wish you can leave those fields blank and just click "next". This will open the print-out summary of the test results. You can now either print (Ctrl+P or "File" then "Print" in your menu) or save the results.
To save the results to your computer select "File" from your menu (upper left hand corner) and then select "Save page as". Now specify the location where you want to save the results (e.g. in the patient's folder or on your desktop). This will create a .htm file. When you are opening this file the next time, your computer will automatically open a web browser window (e.g. Internet Explorer or Firefox) and display the results as a website.
If you have a pdf writer installed to your computer you can also save a pdf of the test results. To download a free version of a pdf writer click here, download the software and follow the installation instructions on that website. Once the installation is completed, the pdf writer will come up as a printer in your list of available printers. Select the pdf writer from the drop-down list in your printer settings and hit the "OK" button. The computer will now ask you where to save the pdf. Just select the location you wish to save the pdf to and confirm by clicking "Save" or "OK". Top
11. How long does it take to administer the GPCOG?
The administration of the paper-and-pencil test takes less than four minutes for the patient assessment and less than two minutes to interview an informant (Brodaty, H., et al., The GPCOG: a new screening test for dementia designed for general practice. Journal of the American Geriatrics Society, 2002. 50(3):530-4). Unless you have a very slow internet connection, the web-based GPCOG should not take you any longer. It might be a good idea though to familiarise yourself with both the paper-and-pencil and the web-based GPCOG prior to your first administration to allow for a smooth flow of the test. Top
12. Is there a training video available?
A training video is available on this website as well as on UNSWTV and on YouTube. Please click here to access it. There is also a short video clip on the background of the GPCOG available at YouTube. Top
13. Where can I find additional information?
On the top section of the website you can find tabs to navigate the website. One is called "GPCOG information". You will find useful information such as references to published articles on the GPCOG or contact details. We also suggest you visit the Wikipedia entry about the GPCOG here. Top
14. What do I do if my patient is cognitive impaired?
The website provides you with helpful links on what to do next and where to look for help.
For instance, you will be provided with a list of recommended standard investigations that should be conducted once you have detected impairment in your patient. This is mainly to rule out reversible causes of dementia such as vitamin B12 deficiency and also to optimise your patient's care. You can access this list of recommended standard investigations here. As recommendations may vary by country we have created a spreadsheet of investigations broken down by countries/evidence based guidelines recommending the specific test. To download this spreadsheet click here.
Your patients and their families might also ask for further information and help. Useful hints and information for patient and families can be accessed through Alzheimer Associations worldwide. The website provides you with links to national and international Alzheimer Associations. You will find those links under the "National Guidelines" tab at the top of the website. Top
Background
1. What is the purpose of this website?
The purpose of this website is to enhance GP diagnosis of dementia by providing a screening tool which is brief and easy to administer, recommending standard investigations that should be conducted once cognitive impairment is detected and linking to national and international evidence-based guidelines on the assessment and management of dementia in primary care. Top
2. Who developed the GPCOG?
The paper-and-pencil GPCOG was developed by Henry Brodaty, Dimity Pond, Nicola Kemp, Georgina Luscombe, Louise Harding, Karen Berman and Felicia Huppert.
The original reference of the published article is Brodaty H, Pond D, Kemp NM, et al. The GPCOG: a new screening test for dementia designed for general practice. Journal of the American Geriatrics Society, 2002. 50(3):530-534. Top
3. Who funded the development of the GPCOG?
The development of the paper-and-pencil GPCOG was funded by a National Health and Medical Research Council (NHMRC) grant. The GPCOG website received funding from the Canadian National Initiative for the Care of the Elderly (NICE), the International Collaboration for the Care of the Elderly (ICCE) and the Dementia Collaborative Research Centres (DCRCs). Top
4. Do you have any commercial interests? Are any pharmaceutical companies involved in this project?
No, we do not have any commercial interest in the GPCOG nor is any pharmaceutical company involved in this website/the GPCOG itself. The GPCOG is freely available for clinicians. Top
5. Is the GPCOG currently used in research?
The GPCOG website and the web-based GPCOG are currently under systematic evaluation regarding its user acceptance and utility. First results are expected for mid 2010.
There is also international research being conducted on the evaluation and validation of translated GPCOG versions. If you are using the GPCOG in your research we are keen to learn more about it. Please just send us an email to gpcog@unsw.edu.au Top
6. Is the GPCOG a recommended screening tool for dementia?
Yes, the GPCOG has been recommended in scientific literature reviews and by evidence based guidelines to be a valid and efficient tool to screen for dementia. We have listed some of the relevant references for you:
- Lorentz, W.J., Scanlan, J.M. and Borson, S., Brief screening tests for dementia.. Canadian Journal of Psychiatry - Revue Canadienne de Psychiatrie, 2002. 47(8):723-33.
- Milne, A., et al., Screening for dementia in primary care: a review of the use, efficacy and quality of measures. International Psychogeriatrics, 2008. 20(5):911-26.
- Brodaty, H., et al., What is the best dementia screening instrument for general practitioners to use? American Journal of Geriatric Psychiatry, 2006. 14(5):391-400.
- Bridges-Webb, C. et al ., Care of patients with Dementia in General Practice - Guidelines. NSW Health, 2003 , Bridges-Webb et al 2003, Royal Australian College of General Practitioners (RACGP)
- Culverwell, A. et al., Screening for dementia in primary care: how is it measuring up? Quality in Ageing, 2008. 9(3):39-44
Copyright
1. Who can download or use the GPCOG?
The GPCOG can be used by anyone. Having said that, it is important to bear in mind that the GPCOG is a clinical tool and it should not be administered by concerned family members or unexperienced staff. Make sure you read the instructions prior to your first administration of the GPCOG.
If you are not a clinician but concerned about a family member's memory difficulty please ask your family member's GP or your GP to administer the GPCOG to them. The GP might then ask you to take part in the assessment as the informant and provide important information. Top
2. What are the costs for using the GPCOG?
The GPCOG is free for clinicians and researchers. Use of the website or downloading the paper-and-pencil test doesn't cost anything. However, we do ask you not to change any content of the GPCOG and also to have the original reference printed on the worksheets (Brodaty et al, JAGS 2002; 50:530-534). Commercial companies seeking permission to use the GPCOG should write to gpcog@unsw.edu.au. Top
3. Can I reprint the GPCOG?
If you are using the GPCOG for clinical purposes, you can download and print out as many copies of the paper GPCOG in as many languages as you wish. You can also access the website and administer the web-based GPCOG as many times as you wish.
However, if you intend to re-print the GPCOG for your own research articles, published work or website, we ask you to seek permission from the Journal of the American Geriatrics Society. We also ask you to acknowledge the authors of the original GPCOG publication in any publication arising from your research work with the GPCOG. Top
4. I am using the GPCOG for research purposes. Do I have to acknowledge the authors of the GPCOG?
Please acknowledge the authors of the original GPCOG publication in any publication arising from your research with the GPCOG. Top
5. I am interested in translating the GPCOG into a certain language. Can I do so? Who do I have to contact?
We are always open to researchers/research groups wanting to do translation and validation work on the GPCOG. If you are interested in translating the GPCOG just send an email to gpcog@unsw.edu.au Top
