A 2016 survey by The Mayo Clinic found that Americans consider neurological conditions such as dementia to be among the country’s greatest healthcare challenges, with nearly two-thirds of baby boomers concerned about brain health. That’s understandable considering how mentally, physically, and emotionally challenging dementia is for both patients and their families. But the benefits of early assessment for cognitive impairment should  far outweigh the fear of diagnosis.

Early diagnosis of cognitive impairment or dementia benefits both patients and clinicians. Affected individuals and their families can better meet needs and plan for the future, and clinicians can deliver appropriate care, better manage a patient’s comorbid conditions, and avoid prescribing medications that may worsen cognition or function, preventing avoidable health complications and costly hospitalization and readmissions.

Is Routine Screening the Answer?

Studies suggest physicians are unaware of cognitive impairment in more than 40% of their cognitively impaired patients.2 In many cases, symptoms of cognitive impairment overlap with those of other medical conditions, presenting diagnostic challenges. But often, impairment is simply unrecognized in affected patients by their physicians.

The U.S. Preventive Services Task Force, in its review and recommendation regarding routine screening for cognitive impairment, noted that “although the overall evidence on routine screening is insufficient, clinicians should remain alert to early signs or symptoms of cognitive impairment (for example, problems with memory or language) and evaluate as appropriate.”3

Family Intervention

For individuals who express memory concerns or other cognitive complaints, exhibit non-memory triggers such as personality change, depression, deterioration of chronic disease without explanation, and/or experience falls or balance issues, screening for cognitive impairment is critical.

Family members may be more likely than impaired individuals to request an assessment. Notably, the Alzheimer’s Association recommends screening following informant reports of cognitive impairment, with or without patient concurrence.4

Aided by anecdotal evidence and visual clues, cognitive screening is the only way to determine baseline cognition and to track progression. Traditional cognitive screening tools such as the Mini-Cog, while effective, have limitations. The results can be influenced by patients’ level of education, literacy, and other factors. Administrative biases may impact subjective interpretation.5 Finally, a reliance on paper- based test results makes it difficult to quantify impairment and progression over time because they cannot be stored in patients’ digital health records.

Digital Assessment Tools

Digital cognitive assessment tools (such as CogniSense) may help to increase early identification of cognitively impaired patients, helping to drive down the percentage of undiagnosed patients. With early diagnoses, patients may also stay in the care of their personal physician, who can track progression until cognitive impairment progresses or additional care is needed.

Most importantly, these early evaluations provide information that allows family physicians to implement treatment plans and interventions that may delay progression, helping patient and family members preserve health and quality of life for as long as possible.

References

  1. Mayo Clinic. http://healthcheckup.mayoclinic.org/. Accessed January 26, 2017.
  2. Chodosh J, Petitti DB, Elliott M, et al. Physician recognition of cognitive impairment: Evaluating the need for improvement. Journal of the American Geriatrics Society. 2004;52(7):1051–1059.
  3. Final recommendation statement: Cognitive impairment in older adults: Screening. https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/cognitive-impairment-in-older-adults-screening. Accessed January 26, 2017.
  4. Cognitive assessment. http://www.alz.org/health-care-professionals/cognitive-tests-patient-assessment.asp. Accessed January 26, 2017.
  5. Cordell CB, Borson S, Boustani M, et al. Alzheimer’s association recommendations for operationalizing the detection of cognitive impairment during the Medicare annual wellness visit in a primary care setting. Alzheimer’s & Dementia. 2013;9(2):141–150.