Alzheimer’s Association Publishes Assessment Recommendations
Simple tools can detect impairment (Dec. 20)The Alzheimer’s Association, based in Chicago, Ill., has released guidance to help healthcare providers detect cognitive impairment as part of the Medicare Annual Wellness Visit (MAWV). While physicians are required to include detection of cognitive impairment as part of the MAWV, until now there has been no comprehensive guidance to physicians on how to accomplish that goal.
Detecting possible cognitive impairment is the first step in determining whether further evaluation is needed. In developing the recommendations, the association convened a group of experts to survey the current literature and to build consensus around a practical and effective process that could be used in the primary care setting.
The recommendations will be published online in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association.
It has been estimated that, among the more than 5 million Americans with Alzheimer’s disease, as many as half have not been diagnosed.
The association’s workgroup explored whether there was consensus in the literature concerning validated tools and commonly used rule-out assessments that were most suited for primary care practitioners. In addition to the range of tools identified, the new recommendations offer suggested questions to include in the required Health Risk Assessments that patients must provide for the visit. The recommendations include tools that are available in multiple languages and are unaffected by levels of education or different cultural backgrounds.
While the workgroup emphasizes in its recommendations that “no one tool is recognized as the best brief assessment to determine if a full dementia evaluation is needed,” several tools were found most suited for assessing cognitive impairment at no cost to the health care provider during the visit. These include the Mini-Cog, the Memory Impairment Screen (MIS), and the General Practitioner Assessment of Cognition (GPCOG). These tests are relatively free of education, race, or cultural bias and take 5 minutes or less to administer. Recognized tools suited for those close to the patient –– such as spouses, family members, or friends –– were the AD8 screening tool, the Short Informant Questionnaire on Cognitive Decline in the Elderly (short IQCODE), and the Informant GPCOG.
According to the association, the use of one of these tools allows clinicians to obtain an objective score that indicates either a passed or failed cognitive assessment and can improve the detection of impairment that should be further evaluated.
Source: Alzheimer’s Association; December 20, 2012.