Cognitive measures lacking in EHR prior to dementia or Alzheimer's disease diagnosis

Maserejian, Nancy N.; Krzywy, Henry; Eaton, Susan; Galvin, James E.

doi:10.1002/alz.12280

Cited by 15 publications

(12 citation statements)

References 32 publications

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“…Addition of the mPPT to examine physical functionality also dovetails well with the providers evaluation of frailty and falls risk in older adults. Completing the mCAIDE first to identify at-risk individuals could provide a two-staged approach and led to increase cognitive testing which is infrequently documented in electronic health records, particularly in minority and economically disadvantaged populations [58].…”

Section: Discussionmentioning

confidence: 99%

A Modified CAIDE Risk Score as a Screening Tool for Cognitive Impairment in Older Adults

Tolea

Heo

Chrisphonte

et al. 2021

JAD

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Background: Although an efficacious dementia-risk score system, Cardiovascular Risk Factors, Aging, and Dementia (CAIDE) was derived using midlife risk factors in a population with low educational attainment that does not reflect today’s US population, and requires laboratory biomarkers, which are not always available. Objective: Develop and validate a modified CAIDE (mCAIDE) system and test its ability to predict presence, severity, and etiology of cognitive impairment in older adults. Methods: Population consisted of 449 participants in dementia research (N = 230; community sample; 67.9±10.0 years old, 29.6%male, 13.7±4.1 years education) or receiving dementia clinical services (N = 219; clinical sample; 74.3±9.8 years old, 50.2%male, 15.5±2.6 years education). The mCAIDE, which includes self-reported and performance-based rather than blood-derived measures, was developed in the community sample and tested in the independent clinical sample. Validity against Framingham, Hachinski, and CAIDE risk scores was assessed. Results: Higher mCAIDE quartiles were associated with lower performance on global and domain-specific cognitive tests. Each one-point increase in mCAIDE increased the odds of mild cognitive impairment (MCI) by up to 65%, those of AD by 69%, and those for non-AD dementia by > 85%, with highest scores in cases with vascular etiologies. Being in the highest mCAIDE risk group improved ability to discriminate dementia from MCI and controls and MCI from controls, with a cut-off of ≥7 points offering the highest sensitivity, specificity, and positive and negative predictive values. Conclusion: mCAIDE is a robust indicator of cognitive impairment in community-dwelling seniors, which can discriminate well between dementia severity including MCI versus controls. The mCAIDE may be a valuable tool for case ascertainment in research studies, helping flag primary care patients for cognitive testing, and identify those in need of lifestyle interventions for symptomatic control.

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Section: Discussionmentioning

confidence: 99%

A Modified CAIDE Risk Score as a Screening Tool for Cognitive Impairment in Older Adults

Tolea

Heo

Chrisphonte

et al. 2021

JAD

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“…Cognitive assessment tools are not routinely or fully integrated into EHRs; only 11% of dementia patients had a cognitive measure documented in their EHR in the 5 years prior to diagnosis 21 . Work group members agreed that it is important to integrate BCAs into EHRs.…”

Section: Resultsmentioning

confidence: 99%

“…16 Indeed, only 11% of dementia patients and 24% of AD patients had their cognitive status documented in their EHR systems in the 5 years before diagnosis. 21 Identifying quick and affordable solutions that easily integrate into the clinician's workflow and EHRs should be an immediate goal.…”

Section: Introductionmentioning

confidence: 99%

“…Few cognitive assessment tools are integrated with electronic health record (EHR) systems unless specifically requested and configured by the health‐care system, resulting in significant administrative burdens for clinicians to log and track results and receive reimbursement for conducting them 16 . Indeed, only 11% of dementia patients and 24% of AD patients had their cognitive status documented in their EHR systems in the 5 years before diagnosis 21 . Identifying quick and affordable solutions that easily integrate into the clinician's workflow and EHRs should be an immediate goal.…”

Section: Introductionmentioning

confidence: 99%

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Expanding the use of brief cognitive assessments to detect suspected early‐stage cognitive impairment in primary care

Mattke

Batie

Chodosh

et al. 2023

Alzheimer's & Dementia

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IntroductionMild cognitive impairment remains substantially underdiagnosed, especially in disadvantaged populations. Failure to diagnose deprives patients and families of the opportunity to treat reversible causes, make necessary life and lifestyle changes and receive disease‐modifying treatments if caused by Alzheimer's disease. Primary care, as the entry point for most, plays a critical role in improving detection rates.MethodsWe convened a Work Group of national experts to develop consensus recommendations for policymakers and third‐party payers on ways to increase the use of brief cognitive assessments (BCAs) in primary care.ResultsThe group recommended three strategies to promote routine use of BCAs: providing primary care clinicians with suitable assessment tools; integrating BCAs into routine workflows; and crafting payment policies to encourage adoption of BCAs.DisscussionSweeping changes and actions of multiple stakeholders are necessary to improve detection rates of mild cognitive impairment so that patients and families may benefit from timely interventions.

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“…No method for identifying latent factors of cognitive impairment itself within EMR, and not just determining risk factors, has been successful to date. Thus, to properly screen for prodromal impairment, components that directly assess cognitive and daily functioning must be incorporated into the medical record [32].…”

Section: Cost-sensitive Cognitive Screeningmentioning

confidence: 99%

Hierarchical Two-Stage Cost-Sensitive Clinical Decision Support System for Screening Prodromal Alzheimer’s Disease and Related Dementias

Kleiman

Ariko

Galvin

2022

Preprint

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Background: The detection of subtle cognitive impairment in a clinical setting is difficult, and because time is a key factor in small clinics and research sites, the brief cognitive assessments that are relied upon often misclassify patients with very mild impairment as normal. In this study, we seek to identify a parsimonious screening tool in one stage, followed by additional assessments in an optional second stage if additional specificity is desired, tested using a machine learning algorithm capable of being integrated into a clinical decision support system. Methods: The best primary stage incorporated measures of short-term memory, executive and visuospatial functioning, and self-reported memory and daily living questions, with a total time of 5 minutes. The best secondary stage incorporated a measure of neurobiology as well as additional cognitive assessment and brief informant report questionnaires, totaling 30 minutes including delayed recall. Combined performance was evaluated using 25 sets of models, trained on 1181 ADNI participants and tested on 127 patients from a memory clinic. Results: The 5-minute primary stage was highly sensitive (96.5%) but lacked specificity (34.1%), with an AUC of 87.5% and DOR of 14.3. The optional secondary stage increased specificity to 58.6%, resulting in an overall AUC of 89.7% using the best model combination of logistic regression for stage 1 and gradient-boosted machine for stage 2. Conclusions: The primary stage is brief and effective at screening, with the optional two-stage technique further increasing specificity. The hierarchical two-stage technique exhibited similar accuracy but with reduced costs compared to the more common single-stage paradigm.

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Cognitive measures lacking in EHR prior to dementia or Alzheimer's disease diagnosis

Cited by 15 publications

References 32 publications

A Modified CAIDE Risk Score as a Screening Tool for Cognitive Impairment in Older Adults

A Modified CAIDE Risk Score as a Screening Tool for Cognitive Impairment in Older Adults

Expanding the use of brief cognitive assessments to detect suspected early‐stage cognitive impairment in primary care

Hierarchical Two-Stage Cost-Sensitive Clinical Decision Support System for Screening Prodromal Alzheimer’s Disease and Related Dementias

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