Screening

Your Organisational Guidance

ebpracticenet urges you to prioritise the following organisational guidance:

Guide de pratique clinique pluridisciplinaire relatif à la collaboration dans la dispense de soins aux personnes âgées démentes résidant à domicile et leurs aidants prochesPublished by: Groupe de Travail Développement de recommmandations de première ligneLast published: 2017Multidisciplinaire richtlijn voor thuiswonende oudere personen met dementie en hun mantelzorgersPublished by: Werkgroep Ontwikkeling Richtlijnen Eerste Lijn (Worel)Last published: 2017

The ability of screening to significantly change outcomes has not been established.[140]

Studies demonstrate that clinicians and family members under-recognise the early stages of dementia.[141] It is clinically recommended that older people are screened for the presence of mild cognitive impairment (MCI), as well as overt dementia, particularly with the emergence of drugs that may affect the progression of Alzheimer's disease (AD). When AD is detected early, pharmacological and behavioural strategies can be implemented and planning and safety can be discussed most effectively with the patient and their family.

Target population

All older people who present with memory impairment, decline in functional status, mood disorders, or behavioural abnormalities should be screened. Although there is no consensus on the screening of all older people, many geriatricians screen on the first clinic visit and every few years thereafter in those aged ≥65 years. This is helpful as it establishes a baseline for comparison.

In the US, Medicare recommends a cognitive evaluation, including questioning and observing memory concerns, as part of the annual wellness visit. The American Academy of Neurology recommends annual cognitive health assessment for patients 65 years and older.[142]

Cognitive screening tests

Tools include the Folstein Mini-Mental State Examination (MMSE), which has been used for years as a screening test (with high sensitivity for detecting dementia, but which often fails to recognise MCI). More recently, the Montreal Cognitive Assessment (MoCA) has become one of the most commonly used tools. One Cochrane review concluded that it has high sensitivity but low specificity for detecting dementia, but that there is insufficient information to make recommendations on its clinical utility in different settings.[143]​ It has been suggested that MoCA may be used to detect MCI.[100][144][145] Montreal Cognitive Assessment Opens in new window​​​​​​ A version of the MoCA for people with hearing impairment has been developed and validated, and during the pandemic the MoCA was adapted for telephone use and for those with visual impairment.[146]

It should be noted that most of the norms are based on educated Caucasian samples and thus scores in those of other cultures or education levels should be viewed with caution.[147][148][149]​ Several other screening tools are available, such as the Saint Louis University Mental Status (SLUMS) examination and Mini-Cog​​.[95] Saint Louis University School of Medicine: SLUMS Examination Opens in new window Mini-Cog© Opens in new window [ Cochrane Clinical Answers logo ]

The SLUMS examination has better sensitivity for detecting MCI than the MMSE.[130] The SLUMS examination also accounts for educational background when stratifying cognitive functioning, which will become increasingly important as the sensitivity and specificity of early diagnosis is refined.

Meta-analyses indicate that the Mini-Cog may be a useful cognitive screening tool.​​ Mini-Cog© Opens in new window​ However, only a limited number of diagnostic studies using Mini‐Cog are available.[95][97][98][99]​​​​

There is insufficient evidence to recommend the use of self-administered cognitive assessment tools.[103]

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