The Two-Step Strategy Could Be Inadequate and Counteracting to Diagnose Prodromal Dementia or Mild Cognitive Impairment

Abbate, Carlo; Trimarchi, Pietro Davide; Inglese, Silvia; Gallucci, Alessia; Tomasini, Emanuele; Bagarolo, Renzo; Giunco, Fabrizio

doi:10.3389/fnagi.2020.00229

Cited by 6 publications

(9 citation statements)

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“…Third, the study of a dementia syndrome could prove to be a powerful diagnostic tool. In fact, to detect a dementia syndrome, experienced clinicians have used pattern recognition that allows them to readily recognize complex patterns of behavioral and cognitive characteristics from the detection of a few signs and symptoms (Abbate et al, 2020 , 2021b ; Johnson et al, 2021 ), even without or long before the full pattern has manifested. Fourth, it is the anatomy that determines the dementia syndrome (Weintraub and Mesulam, 2009 ), so an accurate definition of the syndrome could suggest which regions are affected by brain degeneration.…”

Section: Discussion: the Reasons Why The Study Of Alzheimer's Syndrom...mentioning

confidence: 99%

Research on Alzheimer's syndromes is critical to improve diagnosis, patient management and non-pharmacological treatments, but is under-pursued

Abbate

2022

Front. Aging Neurosci.

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Section: Discussion: the Reasons Why The Study Of Alzheimer's Syndrom...mentioning

confidence: 99%

Research on Alzheimer's syndromes is critical to improve diagnosis, patient management and non-pharmacological treatments, but is under-pursued

Abbate

2022

Front. Aging Neurosci.

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“…165 If the evaluation is negative, then the patient is generally referred to a subsequent follow-up screening at a later date. Patients with mild to moderate dementia unidentified at the first screening are likely to request a new referral a very short time later, 165,166 as a result of the significant cognitive and/or behavioural disturbances that continue to cause distress to themselves and their families. 165 On the other hand, patients going undetected on first screening might not feel the need for a new referral for a long time because of subtle or selective disturbances.…”

Section: Patient Perspective Of the Labelmentioning

confidence: 99%

“…reducing health-care costs). 165 Commentators have suggested an intermediate '1.5 stage of full detection' 165,166 where a 'frontline' dementia specialist (i.e. a behavioural neurologist, a neuropsychologist, a geriatrician, an old age psychiatrist or an advanced practice nurse) would work alongside a primary care doctor, reviewing data from the first screening of all negative cases and supplementing these with clinical evaluations of the patient's cognitive, affective and behavioural status.…”

Section: Patient Perspective Of the Labelmentioning

confidence: 99%

“…165 Potentially, this model seeks to achieve cost-effectiveness, simultaneously reducing the number of missed first detections of prodromal dementia or MCI and saving the high cost of full assessments provided in specialist settings. 165,166 Direct-to-consumer tools offer the potential to sidestep barriers associated with cognitive evaluation in primary care, therefore improving access to cognitive assessments. 72 However, the health service…”

Section: Patient Perspective Of the Labelmentioning

confidence: 99%

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Assessment and management pathways of older adults with mild cognitive impairment: descriptive review and critical interpretive synthesis

Chambers

Cantrell

Sworn

2022

Health Soc Care Deliv Res

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Background Mild cognitive impairment in older adults is a risk factor for dementia. Mild cognitive impairment is a result of a diverse range of underlying causes and may progress to dementia, remain stable or improve over time. Objectives We aimed to assess the evidence base around the assessment and management pathway of older adults with mild cognitive impairment in community/primary care, hospital and residential settings. Data sources In January 2021, we searched MEDLINE, EMBASE, PsycInfo®, Scopus, Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library (i.e. Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials), Science Citation Index and Social Science Citation Index. The search was limited to studies published in English between 2010 and 2020. Grey literature and citation searches were also performed. Methods We performed two separate evidence reviews: (1) a descriptive review with narrative synthesis focusing on diagnosis, service provision and patient experience; and (2) a critical interpretive synthesis of evidence on the advantages and disadvantages of ‘mild cognitive impairment’ as a diagnostic label. Results A total of 122 studies were included in the descriptive review, of which 29 were also included in the critical interpretive synthesis. Study participants were most commonly recruited from populations of community-living older adults or those who had sought medical help from their general practitioner for memory problems. Follow-up searching identified a further 11 studies for the critical interpretive synthesis. The descriptive review identified multiple barriers to efficient diagnosis, starting with patient reluctance to seek help. General practitioners have a variety of cognitive tests available, but substantial numbers of patients meeting criteria for dementia do not have a diagnosis recorded. Patients may be referred to a memory clinic, but these clinics are mainly intended to identify and support people with dementia, and people with mild cognitive impairment may be discharged back to their general practitioner until symptoms worsen. Availability of scanning and biomarker tests is patchy. Qualitative studies show that patients with mild cognitive impairment and their carers find the process of investigation and diagnosis difficult and frustrating to negotiate. The key finding from the critical interpretive synthesis was that the need for a ‘timely’ diagnosis outweighs the ongoing debate about the value, or otherwise, of early investigation and labelling of memory problems. Determining what is a timely diagnosis involves balancing the perspectives of the patient, the health system and the clinician. Conclusions The two reviews reported here have applied different ‘lenses’ to the same body of evidence. Taken together, the reviews highlight the importance of a timely diagnosis for memory problems and identify barriers to obtaining such a diagnosis, from reluctance to seek help through to patchy availability of advanced diagnostic tests. Limitations The review was primarily descriptive, reflecting the prespecified review questions. Study selection was complicated by lack of a consistent definition of mild cognitive impairment and its overlap with other memory disorders. It was not possible to employ double study selection, data extraction or quality assessment, although processes of checking and verification were used throughout the review. Future work Priorities include evaluating remote methods of memory assessment and preparing for the likely future availability of disease-modifying treatments for early dementia. Research is needed on the investigation of memory problems in hospital and social care settings. Study registration This study is registered as PROSPERO CRD42021232535. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 10. See the NIHR Journals Library website for further project information.

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“…Specifically, the prodromal stage of dementia or better known as Mild Cognitive Impairment (MCI) has been in the limelight in terms of research and clinical practice in the past few years [10][11][12][13]. MCI patients are recognized to be at high risk for developing progressive dementia and subsequently develop dementia [14].…”

Section: Introductionmentioning

confidence: 99%

Older Chinese Adults’ Knowledge, Beliefs, Attitudes and Behaviour on Cognitive Health and Ageing: An Exploratory Study in Singapore

Grillo¹

2021

International Journal on Neuropsychology and Behavioural Sciences (IJNBS)

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Introduction: In recent years there has been increasing strategies to delay onset or progression of dementia, and identification of its modifiable risk factors. Given the collective emphasis on dementia prevention, an in-depth exploratory study is needed to enrich previous research and provide insights on current behaviours and attitudes towards dementia prevention. We aim to investigate the knowledge, beliefs, attitude and behaviour of older Chinese adults on cognitive health and ageing to identify motivators and barriers towards activities of dementia risk reduction. Methods & Materials: In-depth interviews were conducted with 25 older Chinese adults between 50-75 years. The COM-B Framework from the Behavioural Change Wheel was used in the discussion guide design, and to identify themes to cover a. knowledge on brain health; b. perceptions of people with cognitive decline, impairment, and related conditions; and c. habits of maintaining a healthy lifestyle. Results: Four common insights identified were: a. Overall understanding of dementia remained low even as the word dementia was particularly recognizable among informants; b. Mental health was instinctively perceived to be integral to cognitive health; c. Presence of stigma towards the at-risk population of dementia and its support services; d. There was a basic knowledge of modifiable risk factors of dementia, but the knowledge did not always translate into preventive and health-seeking behaviour for brain health. Conclusion: The study has adopted an innovative approach in using the COM-B Framework of Behaviour Change to unveil motivators and barriers that would influence perceptions of older Chinese adults towards cognitive health and ageing. Elements of behaviour change identified in our research can be used to support older adults and their communities to gain more awareness about dementia, reduce risks and address challenges experienced, creating a supportive community for those at risk and having dementia.

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The Two-Step Strategy Could Be Inadequate and Counteracting to Diagnose Prodromal Dementia or Mild Cognitive Impairment

Cited by 6 publications

References 46 publications

Research on Alzheimer's syndromes is critical to improve diagnosis, patient management and non-pharmacological treatments, but is under-pursued

Research on Alzheimer's syndromes is critical to improve diagnosis, patient management and non-pharmacological treatments, but is under-pursued

Assessment and management pathways of older adults with mild cognitive impairment: descriptive review and critical interpretive synthesis

Older Chinese Adults’ Knowledge, Beliefs, Attitudes and Behaviour on Cognitive Health and Ageing: An Exploratory Study in Singapore

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