Screening for Cognitive Impairment in Older Adults

Patnode, Carrie D.; Perdue, Leslie A; Rossom, Rebecca C.; Rushkin, Megan C.; Redmond, Nadia; Thomas, Rachel; Lin, Jennifer S

doi:10.1001/jama.2019.22258

Cited by 185 publications

(122 citation statements)

References 344 publications

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“…Subjective memory complaints have been found useful to detect early AD [33]. Likewise objective screening tests have been found useful [34]. In fact it seems reasonable to not rely on subjective memory impairment to decide on whom further procedures are initiated but rather to include the results of objective tests in this decision [35].…”

Section: Discussionmentioning

confidence: 99%

On the conundrum of cognitive impairment due to depressive disorder in older patients

et al. 2020

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Objectives Depressive symptoms and cognitive impairment often concur in older persons. Differentiating the cause of cognitive impairment in older persons with Depressive Disorder (DD) from other diseases such as Alzheimer's Disease (AD) is challenging. The goal of this study was to characterize cognitive impairment in older persons with DD. Design Cross-sectional retrospective observational clinical cohort study using patient records from 2014 to 2018. Setting Gerontopsychiatric services of Ulm University at Bezirkskrankenhaus Gü nzburg serving as primary psychiatric care institution and tertiary referral center for psychiatric care for older persons. Partcipants DD was diagnosed according to ICD-10 criteria. When indicated by the medical history or neuropsychological assessment further diagnostic procedures were initiated. Cerebrospinal fluid (CSF) tap was routinely the first additional procedure. If patients did not consent to CSF tap or contraindications were present, 18 F-fluordesoxyglucose-PET (FDG-PET) or Amyloid-PET (Am-PET) were performed. Materials and methods Extensive neuropsychological test battery to assess cognitive profile. Results 457 subjects were diagnosed with DD (DD-all; age 50-94; 159 males, 298 females). Biomarkers were assessed in 176 persons; in 90 of these subjects AD-biomarkers were negative (DD-BM-; age 54-89; 40 males, 50 females), and in 86 subjects at least one biomarker

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Section: Discussionmentioning

confidence: 99%

On the conundrum of cognitive impairment due to depressive disorder in older patients

et al. 2020

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“…Barriers to early detection are well documented including workforce shortages 43 and low confidence for the yield on routine screening based on age or other risk factors. 44 Payment reform is one approach to addressing both of these barriers.…”

Section: Discussionmentioning

confidence: 99%

Recommendations to Improve Payment Policies for Comprehensive Dementia Care

Haggerty

Epstein‐Lubow

Spragens

et al. 2020

J American Geriatrics Society

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Access to comprehensive dementia care is limited. Recent changes in billing for professional services, including new physician fee schedule codes, encourage clinicians to provide new services; however, current reimbursement does not cover costs for all needed elements of dementia care. The Payment Model for Comprehensive Dementia Care Conference convened more than 50 national experts from diverse perspectives to review promising strategies for payment reform including ways to accelerate their adoption. Recommendations for reform included payments for services to family caregivers; new research to determine success metrics; education for consumers, providers, and policymakers; and advancing a population health model approach to tier coverage based on risk and need within a health system.

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“…In addition to the 16 tests selected by the USPSTF, 13,14 others have recommended the Modified Mini-Mental Examination (3MS), 15 a four-item version of the MoCA, 16,17 and the Rowland Universal Dementia Assessment Scale (RUDAS), 18,19 all of which will be addressed below.…”

Section: Discussionmentioning

confidence: 99%

One Size Does Not Fit All: Choosing Practical Cognitive Screening Tools for Your Practice

Molnar

Benjamin

Hawkins

et al. 2020

J American Geriatrics Society

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Every year, millions of patients worldwide undergo cognitive testing. Unfortunately, new barriers to the use of free open access cognitive screening tools have arisen over time, making accessibility of tools unstable. This article is in follow-up to an editorial discussing alternative cognitive screening tools for those who cannot afford the costs of the Mini-Mental State Examination and Montreal Cognitive Assessment (see www.dementiascreen.ca). The current article outlines an emerging disruptive "free-to-fee" cycle where free open access cognitive screening tools are integrated into clinical practice and guidelines, where fees are then levied for the use of the tools, resulting in clinicians moving on to other tools. This article provides recommendations on means to break this cycle, including the development of tool kits of valid cognitive screening tools that authors have contracted not to charge for (i.e., have agreed to keep free open access). The PRACTICAL.1 Criteria (PRACTIcing Clinician Accessibility and Logistical Criteria Version 1) are introduced to help clinicians select from validated cognitive screening tools, considering barriers and facilitators, such as whether the cognitive screening tools are easy to score and free of cost. It is suggested that future systematic reviews embed the PRACTICAL.1 criteria, or refined future versions, as part of the standard of review. Methodological issues, the need for open access training to insure proper use of cognitive screening tools, and the need to anticipate growing ethnolinguistic diversity by developing tools that are less sensitive to educational, cultural, and linguistic bias are discussed in this opinion piece.

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Screening for Cognitive Impairment in Older Adults

Cited by 185 publications

References 344 publications

On the conundrum of cognitive impairment due to depressive disorder in older patients

On the conundrum of cognitive impairment due to depressive disorder in older patients

Recommendations to Improve Payment Policies for Comprehensive Dementia Care

One Size Does Not Fit All: Choosing Practical Cognitive Screening Tools for Your Practice

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