1) What is the purpose of the GPCOG?
2) How does the online GPCOG work?
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 impaired even though they are not (false positives). The chances of this happenning are very small and depend on the prevalence of cognitive impairment in the given population.
3) How is the GPCOG scored?
Click the "Start Test" button on the homepage. The following page reminds you of some basic instructions on how to administer the GPCOG. On the following pages, each GPCOG question will be presented to you separately. Read out each question (blue 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, you will be provided 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. To start the informant interview at a later stage just access it through the homepage, read out the questions as they are presented on the screen and mark the responses accordingly. Once you have pressed the "Next" button, the total score for this section will be generated.
4) What to keep in mind when administering the GPCOG?
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.
Scoring the informant interview:
For the informant interview, "yes"-responses indicate impairment; hence each question that was not answered "yes" (i.e. "no", "don't know" or "N/A") scores one point. To get the total score, add the number of items answered "no", "don't know" or "N/A", resulting in 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.
5) Do I have to complete the informant interview?
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.
- Make sure that 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 (blue 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 changed compared to a few years ago.
6) Are the web-based GPCOG and the paper-and-pencil test the same?
If the patient scores between 5 and 8 out of 9 in the cognitive assessment, you 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. You can also complete it over the phone if that is more convenient.
If the patient scores 9 or between 0 and 4 out of 9 the informant interview is not required. However, you may conduct it if you wish.
7) Do I have to administer the informant interview the same day?
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.
8) Can I enter the answers while the patient is still in my practice?
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).
9) Do I get a print-out of the test results for my records?
Yes. 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.
10) Can I save the results onto my computer?
Yes. 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. You will be asked to enter the name and date of birth of the patient. 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 be generated even if you leave these boxes empty.
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 patient results are not stored.
11) How long does it take to administer the GPCOG?
You can save your patient's results by saving the PDF that you can generate after completing the test (see previous question).
To do so, just click on the link to save or print out the summary once you have completed the patient and/or informant assessment. You can fill in the name and date of birth of the patient. Please note this information is for your records only and will NOT be saved on our servers. If you wish, you can leave those fields blank.
12) Is there a training video available?
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. 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.
13) Where can I find additional information?
A training video and a short video clip on the background of the GPCOG are available at YouTube.
14) What do I do if my patient is cognitively impaired?
This website provides useful background information such as references to published articles on the GPCOG or contact details. We also suggest you visit the Wikipedia entry about the GPCOG.
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 an overview of recommended standard investigations that should be conducted once you have detected impairment in your patient, and the conditions they seek to exclude or confirm. As recommendations may vary by country, we have created an overview of investigations broken down by national evidence-based guidelines.
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. This website provides you with links to national and international Alzheimer Associations under the For carers section.
1) What is the purpose of this website?
2) Who developed the GPCOG?
The purpose of this website is to enhance GP diagnosis of dementia by providing a screening tool which is brief and easy to administer, and by recommending standard investigations that should be conducted once cognitive impairment is detected, based on national and international evidence-based guidelines on the assessment and management of dementia in primary care.
3) Who funded the development of 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.
4) Do you have any commercial interests? Are any pharmaceutical companies involved in this project?
The development of the paper-and-pencil GPCOG was funded by an Australian 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).
5) Is the GPCOG currently used in research?
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.
6) Is the GPCOG a recommended screening tool for dementia?
Different translations of the GPCOG have been and are evaluated and validated internationally. If you are using the GPCOG in your research we are keen to learn more about it. Please contact us at email@example.com.
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, Royal Australian College of General Practitioners (RACGP), 2003.
- Culverwell, A. et al., Screening for dementia in primary care: how is it measuring up? Quality in Ageing, 2008. 9(3):39-44.
1) Who can download or use the GPCOG?
2) What are the costs for using the GPCOG?
The GPCOG can be used by anyone. However, 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.
3) Can I reprint the GPCOG?
The GPCOG is free for clinicians and researchers. There is no fee for use of the website or downloading the paper-and-pencil test. However, you are not allowed to change any content of the GPCOG and are required to include the original reference on the worksheets (Brodaty et al, JAGS 2002; 50:530-534). Commercial companies seeking permission to use the GPCOG should write to firstname.lastname@example.org to obtain a license.
4) I am using the GPCOG for research purposes. Do I have to acknowledge the authors of 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.
5) I am interested in translating the GPCOG into a certain language. Can I do so? Who do I have to contact?
Please acknowledge the authors of the original GPCOG publication in any publication arising from your research with the GPCOG.
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 contact us via email@example.com.