Mom refused to admit she was having memory loss. A very smart woman, she knew how to hide signs of her cognitive decline, whether it was looking at the calendar on the far wall when she was queried about the month and the year or replying, and “Dorian, you were there, too. You describe it.” Her situation brings me to the question – what if the person who may be having cognitive decline can’t – or won’t -- describe the issues that he or she is facing? What can be done?
It turns out that additional feedback can be sought from relatives and friends who have known the person for a while. In fact, when the Alzheimer’s Association published recommendations to help physicians assess whether patient has any cognitive impairment during the Medicare Annual Wellness Visit, three tools that involve spouses, family members and friends were identified. These tools were identified by experts who were convened by the association to review the current literature and built a consensus about a process that would be easy and affective and that could be conducted in a primary care setting. So let’s learn a little bit more about each of these tools.
This screening is an instrument offered by Washington University’s Alzheimer’s Disease Research Center. This particular questionnaire asks relative or friends eight questions to gauge whether a cognitive change has occurred in the person’s thinking and memory over a several year period.
This assessment looks at issues with judgment (such as difficulty making decisions and problems with thinking), interest in hobbies and activities, repeating oneself, difficulty learning new skills using a tool, appliance or gadget, difficulty remembering the correct month or year, difficulty handling financial affairs, difficulty remembering appointments, and daily issues with thinking and/or memory.
Short Informant Questionnaire on Cognitive Decline in the Elderly
Short Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), which was developed at the Australian National University, is designed as a screening tool to access cognitive decline and dementia in the elderly. This questionnaire is designed to be completed by a relative or friend who has known the elder for at least 10 years.
In this questionnaire, the relative or friend is asked to rate whether the person’s memory or intelligence has improved, remained the same or worsened over the past decade. Therefore, if the person was forgetful 10 years ago and continues to have the same level of forgetfulness presently, the relative or friend would rate the elder as “Hasn’t changed much.”
Questions in this section cover issues such as recalling details about friends (occupations, birthdays, addresses), recent conversations, the person’s own address and telephone number, the day and the month, how to work familiar machines found in the home, learning to use new things or a new gadget/machine, handling money while shopping, following the narrative in a book or on a television show, dealing with financial matters, and making daily decisions on everyday matters.
Informant General Practitioner Assessment of Cognition (GPCOG)
This screening offers two components. One of these is a cognitive assessment that the health care practitioner conducts with the person who may have be experiencing some cognitive issues. The second assessment involves a questionnaire completed by an informant, such as a relative or friend. The informant is asked to compare the person’s ability to that of a few years ago.
Questions in this assessment that are asked of the relative or friend focus on whether the person is experiencing any of the following: difficulty remembering recent events; difficulty remembering conversations that happened a few days earlier; difficulty finding the right word or using wrong words more often when speaking; inability to manage money and financial affairs; inability to manage medications independently; and need for more assistance with public or private transportation.
As part of a loved one’s life, you can provide valuable insight into changes in cognitive ability. But I’d also encourage you not to jump to conclusions about what is wrong if a loved one is experiencing memory loss or other cognitive decline. There are many possibilities, ranging from dementia to interacting medications. Therefore, if you are seeing any changes, work with the doctor to determine what exactly is happening and what next steps should be taken. These screening tools are important to identify issues. A full evaluation should be considered by the physician afterward to determine what may be causing these issues.
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.
Australian National University. (2012). Informant questionnaire on cognitive decline in the elderly.
Patient.co.uk. (2010). General practitioner assessment of cognition (GPCOG) score.
Washington University. (2005). AD8 dementia screening interview.
Published On: January 10, 2013