CCCDTD5 recommendations on early and timely assessment of neurocognitive disorders using cognitive, behavioral, and functional scales

Abstract

Introduction Earlier diagnosis of neurocognitive disorders and neurodegenerative disease is needed to implement preventative interventions, minimize harm, and reduce risk of exploitation in the context of undetected disease. Along the spectrum from subjective cognitive decline (SCD) to dementia, evidence continues to emerge with respect to detection, staging, and monitoring. Updates to previous guidelines are required for clinical practice. Methods A subcommittee of the 5th Canadian Consensus Conference on Diagnosis and Treatment of Dementia (CCCDTD) reviewed emerging evidence to address the following: (1) Is there a role for screening at‐risk patients without clinical concerns? In what context is assessment for dementia appropriate? (2) What tools can be used to evaluate patients in whom cognitive decline is suspected? (3) What important information can be gained from an informant, using which measures? (4) What instruments can be used to get more in‐depth information to diagnose mild cognitive impairment (MCI) or dementia? (5) What is the approach to those with cognitive concerns but without objective changes (ie, SCD)? (6) How do we track response to treatment and change over time? The Grading of Recommendations Assessment, Development, and Evaluation system was used to rate quality of the evidence and strength of the recommendations. Results We recommend instruments to assess and monitor cognition, behavior, and function across the cognitive spectrum, including reports from patient and informant. We recommend against screening asymptomatic older adults but recommend investigation for self‐ or informant reports of changes in cognition, emergence of behavioral or psychiatric symptoms, or decline in function or self‐care. Standardized assessments should be used for cognitive and behavioral change that have sufficient validity for use in clinical practice. Discussion The CCCDTD5 provides evidence‐based recommendations for detection, assessment, and monitoring of neurocognitive disorders. Although these guidelines were developed for use in Canada, they may also be useful in other jurisdictions.

Informant‐based tools for assessment and monitoring of cognition, behavior, and function in neurocognitive disorders: Systematic review and report from a CCCDTD5 Working Group

“…This review complements prior work by providing a critical appraisal of existing literature on informant‐based tools for the assessment and monitoring of cognition, behavior, and function in NCDs. A key CCCDTD5 recommendation was to assess cognition, behavior, and function using validated patient and informant‐based measures 3,23 . This review extends these recommendations by providing specific information and guidance regarding the choice of an informant‐based tool.…”

“…In our previously published guidelines use of one or more informant‐based tools that cover cognition, behavior, or function during assessment for NCDs was strongly recommended 23 . Here, based on above review and discussion, we provide specific recommendations for primary care and specialized memory care settings; however, eventually the choice of a particular tool will depend upon the goals of the assessment and available resources.…”

“…Use of standardized informant‐based tools can help address challenges related to poor patient insight and improve standardization of care 3,23 . However, barriers in routine adoption of these tools in clinical care need to be addressed 15 .…”

“…Informant‐report is an essential part of the overall assessment and monitoring of NCDs as emphasized in the CCCDTD5 guidelines 3,23 . There are several evidence‐based tools appropriate for use in both clinical and research settings to complement the assessment of cognition, behavior, and function during diagnostic or longitudinal assessment of NCDs.…”

“…The fifth CCCDTD convened in October 2019 to ratify the most recent iteration of the guidelines 3 . One of the eight CCCDTD5 themes was the early and timely assessment of NCDs using cognitive, behavioral, and functional scales, and the guidelines around this overall theme have already been published 23 . Within this theme, a sub‐group worked on the question “what important information can be gained from an informant, using which measures?” In this paper, we critically appraise and summarize the literature regarding currently available informant‐based tools.…”