Implementing Routine Cognitive Screening of Older Adults in Primary Care: Process and Impact on Physician Behavior

Borson, Soo; Scanlan, James M.; Hummel, Jeffrey W.; Gibbs, Kathy; Lessig, Mary; Zuhr, Elizabeth

doi:10.1007/s11606-007-0202-8

Cited by 84 publications

(68 citation statements)

References 27 publications

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“…However, in one study [35] nearly half of the patients who screened positive for cognitive impairment refused a diagnostic evaluation. “I’m over 50 with no children. I need to know how to be prepared.” [34]…”

Section: Resultsmentioning

confidence: 99%

Attitudes and preferences towards screening for dementia: a systematic review of the literature

et al. 2015

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BackgroundPopulation screening might provide a mechanism to enable early detection of dementia. Yet the potential benefits, harms or acceptability of such a large-scale intervention are not well understood. This research aims to examine the attitudes and preferences of the general public, health care professionals, people with dementia and their carers towards population screening for dementia.MethodsA systematic review of the international literature was undertaken. A search of fifteen bibliographic databases was conducted (up to 12 July 2012; no language restriction) using terms related to dementia, screening, specific screening tools, case finding, and attitudes and preferences; genetic screening and biomarkers were excluded. All study designs were included except opinion-based papers. Included papers were doubly quality assessed and thematically analysed using NVivo.Results29,910 papers were identified of which 29 met the inclusion criteria. We identified seventeen themes relating to the 3 phases of the screening process (pre-, in- and post-screen) – none emerged as more of a facilitator than a barrier to the acceptance of dementia screening. Seven themes emerged in relation to the patient, carer and general population: existing health state; lifestyle and life view; awareness of dementia; role of clinician; communication; benefit; and role of the family. Ten themes emerged in relation to the clinician and healthcare professional: patient’s existing health and comorbidities; awareness of dementia; confidence; duration of patient contact; suitability of screening tool; cost; disclosure; time; treatment and prognosis; and stigma.ConclusionsAs for all screening programmes, screening for dementia raises complex issues around preference and choice for clinicians and the public, and it is unclear what specific factors promote or reduce screening acceptance the most. Overall, the level of evidence is low, few large scale studies have been undertaken and none were conducted in representative samples, all affecting the generalizability of identified themes across healthcare contexts. Nevertheless, our findings suggest that population screening for dementia may not be acceptable to either the general public or health care professionals, and highlight where focused efforts are needed to gain insights into dementia specific issues.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-015-0064-6) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Attitudes and preferences towards screening for dementia: a systematic review of the literature

et al. 2015

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“…Brief cognitive screening instruments are important in both clinical and research settings, particularly as there is a push to include cognitive checkups as part of healthcare wellness visits (Borson et al, 2007; Brayne, Fox, & Boustani, 2007). This was reinforced by the 2010 Patient Protection and Affordable Care Act, which requires providers to “detect any cognitive impairment” as part of the annual wellness visit for Medicare recipients.…”

Section: Discussionmentioning

confidence: 99%

An Abbreviated Montreal Cognitive Assessment (MoCA) for Dementia Screening

Horton

Hynan

Lacritz

et al. 2015

The Clinical Neuropsychologist

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Objective The Montreal Cognitive Assessment (MoCA) is a cognitive screening instrument growing in popularity, but few studies have conducted psychometric item analyses or attempted to develop abbreviated forms. We sought to derive and validate a short form MoCA (SF;MoCA) and compare its classification accuracy to the standard MoCA and MMSE in mild cognitive impairment (MCI), Alzheimer disease (AD), and normal aging. Methods 408 subjects (MCI n=169, AD n=87, normal n=152) were randomly divided into derivation and validation samples. Item analysis in the derivation sample identified most sensitive MoCA items. Receiver Operating Characteristic (ROC) analyses were used to develop cutoff scores and evaluate the classification accuracy of the SF;MoCA, standard MoCA, and MMSE. Net Reclassification Improvement (NRI) analyses and comparison of ROC curves were used to compare classification accuracy of the three measures. Results Serial subtraction (Cramer's V=.408), delayed recall (Cramer's V=.702), and orientation items (Cramer's V=.832) were included in the SF;MoCA based on largest effect sizes in item analyses. Results revealed 72.6% classification accuracy of the SF; MoCA, compared with 71.9% for the standard MoCA and 67.4% for the MMSE. Results of NRI analyses and ROC curve comparisons revealed that classification accuracy of the SF;MoCA was comparable to the standard version and generally superior to the MMSE. Conclusions Findings suggest the SF;MoCA could be an effective brief tool in detecting cognitive impairment.

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“…Sandholzer et al [5] found that only 6% of the German primary care patients who had screened positive for dementia had received any diagnostic assessment or treatment. Borson et al [4] showed that relevant physician behavior (i.e., a formal diagnosis of dementia, specialist referral, or cognitive enhancing medication) occurred for only 17% of the positively screened patients. A reason for the considerably high effect of screening in the present study could have been the active involvement of the participating GPs in a dementia intervention trial that aimed to optimize treatment and care for people with dementia.…”

Section: Discussionmentioning

confidence: 99%

“…The screening of older patients for cognitive impairment could be a method to improve the recognition of dementia. Previous studies have shown that screening for dementia in general practitioners' (GPs) practices did increase the diagnosis rates [4], [5]. Nevertheless, routine screening for dementia has been controversial and is not presently recommended in the dementia guidelines owing to the lack of evidence that patients benefit from it [6], [7], [8].…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, routine screening for dementia has been controversial and is not presently recommended in the dementia guidelines owing to the lack of evidence that patients benefit from it [6], [7], [8]. In addition, patients with positive screening results often undergo no additional diagnostic assessment and do not receive specific treatment [4], [5]. For the benefit of patients, a positive screening outcome should initiate an adequate diagnostic assessment and, depending on the results, state of the art treatment and care.…”

Section: Introductionmentioning

confidence: 99%

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Rates of formal diagnosis of dementia in primary care: The effect of screening

Eichler

Thyrian

Hertel

et al. 2015

Alz & Dem Diag Ass & Dis Mo

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BackgroundScreening could improve recognition of dementia in primary care. We sought to determine the effect of screening for dementia in primary care practices on the formal diagnosis rate; the distribution of differential diagnoses; and the factors associated with receiving a formal diagnosis.MethodsThe “Dementia: life- and person-centered help in Mecklenburg-Western Pomerania” is an ongoing general practitioner (GP)-based, randomized, controlled intervention trial. A total of 4064 community dwelling patients (aged ≥70 years) were screened for dementia in 108 GP practices. Of these patients, 692 (17%) had positive screening results (DemTect score <9). Of these 692 patients, 406 (59%) provided informed consent. The analyses included the data from 243 patients with a complete baseline assessment (preliminary data; January 2014).ResultsOf 146 patients without a formal diagnosis of dementia, 72 (49%) received a formal diagnosis after a positive screening outcome (69% with “unspecified dementia”). Female sex was significantly associated with receiving a formal diagnosis (multivariate analyses).ConclusionScreening improved the identification of dementia considerably. Because of the risk of receiving a false-positive diagnosis, additional diagnostic assessment should be mandatory.

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Implementing Routine Cognitive Screening of Older Adults in Primary Care: Process and Impact on Physician Behavior

Cited by 84 publications

References 27 publications

Attitudes and preferences towards screening for dementia: a systematic review of the literature

Attitudes and preferences towards screening for dementia: a systematic review of the literature

An Abbreviated Montreal Cognitive Assessment (MoCA) for Dementia Screening

Rates of formal diagnosis of dementia in primary care: The effect of screening

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