An expert workgroup brought together by the Alzheimer’s Association has developed a comprehensive guide to help physicians detect cognitive impairment as part of the Medicare Annual Wellness Visit. This group surveyed the current academic literature and then came to agreement about an effective, practical and easy process that health care providers can use in the primary care setting. These recommendations also offer suggest questions that can be included in the Health Risk Assessments that patients provide for the visit.
“We understand that by assessing and documenting cognitive status on an annual basis during the Annual Wellness Visit, clinicians can more easily monitor gradual cognitive decline in a patient over time,” Dr. Bill Thies, Alzheimer’s Association chief medical scientific officer, said in a press release. “Through this workgroup process, we now have a comprehensive recommendation for a brief, step-by-step process to detect cognitive impairment that includes tools for patients and family members as well as an emphasis on vital patient history, self-reported concerns and clinician observations.”
The expert workgroup recommended three specific tools for health care professionals – the Mini-Cog, the Memory Impairment Screen, and the General Practitioner Assessment of Cognition. The taskforce stated that these three types of cognitive assessments are most suited to be used in primary care settings because these tests:
- Have been validated in a primary care setting or a community setting.
- Require no more than five minutes to administer.
- Are easily administered by health care staff members who are not physicians.
- Have highly rated psychometric properties.
- Are free from bias related to education, language and/or culture.
- Are accessible for use in clinics without copyright payments.
The Mini-Cog is a three-minute instrument that is used to screen for cognitive impairment. This assessment involves a three-item recall test for memory as well as a scored clock-drawing test, which is used as an “informative distractor,” according to the American Association for Geriatric Psychiatry (AAGP). This assessment is especially good at recognizing the early stages of dementia as well as detecting dementia among patients who do not speak English or who have low levels of education. The AAGP pointed out that the Mini Cog is especially useful in making diagnoses across the spectrum of dementia; this may be because the assessment screens for executive dysfunction as well as memory.
The Memory Impairment Screen involves a controlled learning of items in four different categories (animal, city, vegetable and musical instrument), a short delay, and then a free recall by naming the item in each category, according to AAGP. “The MIS also demonstrates that individuals can identify the items by their cues and requires all subjects to do the same processing,” the AAGP website explained. “This ensures that decreased recall is due to impaired memory, not impaired attention or different processing strategies.” This assessment is especially helpful in identifying preclinical memory decline that begins as much as 7 years before diagnosis.
The General Practitioner Assessment of Cognition is a reliable, valid and efficient tool that is most appropriate for primary and residential care, according to the Dementia Collaborative Research Centres, which is an Australian Government Initiative. This particular assessment takes four minutes to administer the patient assessment. It also includes a two-minute interview of the caregiver. Patients are asked to remember their first and last name and address (street number, street name and city), state the exact date, draw a clock and put specific numbers in the proper place on the clock face, draw hands on the clock to show a specific time, talk about a news story from the past week, and then recall all components of their name and address.
These three assessments can help identify any memory loss that is taking place. Then it’s up to the medical community to determine what exactly could be causing the memory loss and then take the appropriate steps to help the patient.
Primary Sources for This Sharepost:
Alzheimer’s Association. (2012). Alzheimer’s Association publishes new recommendations for primary care physicians on how to assess cognition during the Medicare annual wellness visit. Press release.
American Association for Geriatric Psychiatry. (2003). Designing brief Alzheimer’s screening tests for use in general medical practice.
Dementia Collaborative Research Centres. (nd). Cognition assessment measures.
Family Practice Notebook. (nd). Dementia screening with GPCOG.
Published On: December 26, 2012