Alzheimer's Association recommendations for operationalizing the detection of cognitive impairment during the Medicare Annual Wellness Visit in a primary care setting

Cordell, Cyndy; Borson, Soo; Boustani, Malaz; Chodosh, Joshua; Reuben, David B.; Verghese, Joe; Thies, William; Fried, Leslie B.

doi:10.1016/j.jalz.2012.09.011

Cited by 478 publications

(360 citation statements)

References 51 publications

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“…Also it should be mentioned that the Mini Mental State Examination (MMSE) is one of the most well-known and used tests [29]. Other examples of cognitive tests not included in [27] are the memorization of interacting objects in the Visual Association Test (VAT) [30] or the detection of the prevalence of the right ear when sounds are memorized by Alzheimer's patients during the Dichotic Listening test [31]. The results provided by this test demonstrate high accuracy and specificity.…”

Section: Previous Workmentioning

confidence: 99%

Cognitive evaluation for the diagnosis of Alzheimer's disease based on Turing Test and Virtual Environments

Montenegro

Argyriou

2017

Physiology & Behavior

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Alzheimer's screening tests are commonly used by doctors to diagnose the patient's condition and stage as early as possible. Most of these tests are based on pen-paper interaction and do not embrace the advantages provided by new technologies. This paper proposes novel Alzheimer's screening tests based on virtual environments and game principles using new immersive technologies combined with advanced Human Computer Interaction (HCI) systems. These new tests are focused on the immersion of the patient in a virtual room, in order to mislead and deceive the patient's mind. In addition, we propose two novel variations of Turing Test proposed by Alan Turing as a method to detect dementia. As a result, four tests are introduced demonstrating the wide range of screening mechanisms that could be designed using virtual environments and game concepts. The proposed tests are focused on the evaluation of memory loss related to common objects, recent conversations and events; the diagnosis of problems in expressing and understanding language; the ability to recognise abnormalities; and to differentiate between virtual worlds and reality, or humans and machines.The proposed screening tests were evaluated and tested using both patients and healthy adults in a comparative study with state-of-the-art Alzheimer's screening tests. The results show the capacity of the new tests to distinguish healthy people from Alzheimer's patients.

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Section: Previous Workmentioning

confidence: 99%

Cognitive evaluation for the diagnosis of Alzheimer's disease based on Turing Test and Virtual Environments

Montenegro

Argyriou

2017

Physiology & Behavior

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“…The Alzheimer's Association of America and the Alzheimer's Foundation have embraced the concept of screening older patients for dementia, with AF sponsoring an annual memory screening day [2]. Medicare guidelines specifically promote identification of cognitive loss as part of the Annual Wellness Visit [3,4] and task forces of the Alzheimer's Association [5] and the Alzheimer's Foundation/ Alzheimer's Drug Discovery Foundation [6] have published detailed approaches to operationalize dementia identification within the Annual Wellness Visit. These organizations and experts recognize the value of identifying cognitive loss within the primary care setting.…”

Section: Editorial Commentmentioning

confidence: 99%

Dementia Screening: Saying No to the USPSTF and Yes to Brief Cognitive Evaluation

Clionsky¹

2014

J Alzheimers Dis Parkinsonism

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Recently, the U.S. Preventive Services Task Force [1] released a widely-publicized review advocating against screening for dementia in older adults. After their review of the literature, they concluded that dementia screening did no harm, but likely did little good. Their position was not based on evidence demonstrating negative outcomes for screening, as they were unable to find any particularly relevant studies that addressed the outcomes question directly. Nor was it based on significant medical risks arising from dementia treatments. They cited the common side effects of cholinesterase inhibitors and memantine, which have been known for decades and are surprisingly minimal for an old and often infirm patient population. Instead, they argued that presently available dementia treatments were not very effective. In other words, if we do not yet have good treatments, why identify the disease state?In our opinion, the USPSTF's reasoning is flawed and their conclusion is potentially harmful to patients suffering from or developing dementia. We believe that the USPSTF position leaves the public and many physicians confused about what to do and the patients with cognitive loss disenfranchised. We Concur, and Here is WhyFirst, and in rebuttal to the USPSTF assertion, the treatment picture for dementia is not as dismal as their position suggests. A contemporaneous review of the same literature [7] makes a convincing case that cholinesterase inhibitors and memantine slow cognitive and functional decline and delay nursing home placement. It also finds that combined treatment is superior to monotherapy. A previous large scale investigation [8] found that patients on continuous anti-dementia treatment lived three years longer, on average, than those who had no treatment or interrupted medication. Add to this a finding from residential care settings [9] documenting better function in patients taking anti-dementia medication, including a reduced need for antipsychotic medications that carry an FDA "black-box" warning. There are a number of single studies with similar findings which became the basis for FDA approval of dementia drugs. We can add to the clinical findings the economic benefit that treatment of dementia with donepezil reduces costs of other medical services [10].But, as noted before, treatment outcome should not be the primary or the governing reason for screening of cognition. In fact, we will argue that screening should be reframed or re-conceptualized in broader terms. We propose to replace the limited concept of screening with a more robust and useful concept called "Brief Cognitive Evaluation" or BCE. Brief Cognitive EvaluationBrief Cognitive Evaluation would employ an economical, easily administered, validated, performance-based tool to produce a metric that is reliable, sensitive to change over time, and useful in broader contexts. In our view, BCE would occur during primary care visits for older patients to measure each patient's global cognitive level as it exists today, just as we measure other impor...

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“…With the inclusion of cognitive assessment as a required part of the affordable care act annual wellness visit for medicare enrollees [2], attention to the process of such screening has increased [3]. Patient performance on such tests can have important implications for treatment in addition to raising potential legal issues.…”

Section: Introductionmentioning

confidence: 99%

Time of Day and Performance on Cognitive Tests in Patients with Mild Dementia

Singh¹,

Gill²,

Rice³

et al. 2016

AND

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Alzheimer's Association recommendations for operationalizing the detection of cognitive impairment during the Medicare Annual Wellness Visit in a primary care setting

Cited by 478 publications

References 51 publications

Cognitive evaluation for the diagnosis of Alzheimer's disease based on Turing Test and Virtual Environments

Cognitive evaluation for the diagnosis of Alzheimer's disease based on Turing Test and Virtual Environments

Dementia Screening: Saying No to the USPSTF and Yes to Brief Cognitive Evaluation

Time of Day and Performance on Cognitive Tests in Patients with Mild Dementia

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