Brain Health: Case Finding of Cognitive Impairment in Primary Care by Using a Risk Score and 2-Pronged Performance-based and Informant-based Assessment Approach

2016 ◽  
Vol 17 (5) ◽  
pp. 460-461 ◽  
Author(s):  
YanHong Dong
Keyword(s):  
Primary Care ◽  
Cognitive Impairment ◽  
Risk Score ◽  
Case Finding ◽  
Brain Health ◽  
Assessment Approach

scholarly journals Feasibility and Acceptability of the Informant AD8 for Cognitive Screening in Primary Healthcare: A Pilot Study

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
YanHong Dong ◽  
Tuck Seng Cheng ◽  
Keith Yu Kei Tsou ◽  
Qun Lin Chan ◽  
Christopher Li-Hsian Chen
Keyword(s):  
Primary Care ◽  
Cognitive Impairment ◽  
Older Adult ◽  
Primary Healthcare ◽  
Primary Care Physicians ◽  
Case Finding ◽  
Adult Patients ◽  
Cognitive Screening ◽  
Healthcare Settings ◽  
Memory Clinics

Objectives.The utility of informant AD8 for case finding of cognitive impairment at primary healthcare settings is unknown and therefore its feasibility and acceptability for targeted screening at a primary healthcare clinic should be investigated.Methods.The informants of older adult patients attending a primary healthcare clinic in Singapore were administered the AD8. Positive screening findings were provided to patients’ primary care physicians for referrals to specialist memory clinics. The acceptability of AD8 was evaluated by collecting feedbacks from the informants and primary care physicians.Results.205 patients and their informants were recruited. However, 6 (2.9%) informants were uncontactable, while the majority of the remaining 199 patients with completed AD8 (96.5%,n=192) found it acceptable where 59 (29.6%) patients were deemed cognitively impaired (AD8 ≥ 2). Clinicians (100%,n=5) found the AD8 helpful in facilitating referrals to memory clinics. However, most referral recommendations (81.4%,n=48) were declined by patients and/or informant due to limited insight of implications of cognitive impairment.Conclusions.The AD8 can be easily administered and is well tolerated. It detected cognitive impairment in one-third of older adult patients and therefore may be useful for case finding of cognitive impairment in the primary healthcare.

scholarly journals Case Finding of Mild Cognitive Impairment and Dementia and Subsequent Care; Results of a Cluster RCT in Primary Care

PLoS ONE ◽  
2016 ◽  
Vol 11 (6) ◽  
pp. e0156958 ◽  
Author(s):  
Pim van den Dungen ◽  
Eric P. Moll van Charante ◽  
Peter M. van de Ven ◽  
Harm W. J. van Marwijk ◽  
Henriëtte E. van der Horst ◽  
...  
Keyword(s):  
Primary Care ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Case Finding ◽  
Cluster Rct

scholarly journals FEASIBILITY AND ACCEPTABILITY OF DETECTING COGNITIVE IMPAIRMENT AND DEMENTIA IN PRIMARY CARE PRACTICES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S782-S782
Author(s):  
Rachel O’Conor ◽  
Julia Yoshino Benavente ◽  
Laura Curtis ◽  
Marina Arvanitis ◽  
Richard Gershon ◽  
...  
Keyword(s):  
Primary Care ◽  
Cognitive Impairment ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Case Finding ◽  
The Us ◽  
Administrative Leaders ◽  
Care Practices ◽  
Primary Care Practices ◽  
And Storage

Abstract As the age of the US population increases, so does cognitive impairment (CI); therefore early detection of CI is critical for ensuring its appropriate management. As part of a NINDS Consortium to detect CI and dementia in primary care (DetectCID), we are implementing and evaluating a brief 2-step CI detection paradigm (MyCog), that can be delivered in clinics with diverse populations via the electronic health record (step 1) and iPad (step 2). We conducted focus groups with 25 clinicians and administrative leaders from academic and community primary care practices to 1) understand how CI is being assessed, and 2) evaluate the feasibility of implementing the MyCog paradigm into existing primary care workflows. Several key themes emerged from the discussions. No proactive detection strategy for CI was regularly used outside of the Medicare Annual Wellness Visits (AWV); variable assessments including the Minicog, MoCA, or MMSE were used to fulfill the AWV requirement. Regarding the feasibility of our MyCog Paradigm, our 2-step process was positively received, with the brief case-finding step 1 satisfying AWV requirements and replacing the longer assessments currently being used. Clinicians preferred that step 2 be self-administered due to limited clinician time for wellness visits, and highlighted logistical challenges such as room availability and storage and maintenance of the iPad. Overall, clinicians felt that the identification of CI was valuable and supported standardization, but indicated regular case finding was unlikely without clear guidance on clinical decision-making.

scholarly journals Usefulness of Orientation to the Year as an Aid to Case Finding of Mild Cognitive Impairment or Depression in Community-Dwelling Older Adults

2021 ◽  
Vol 18 (15) ◽  
pp. 8096
Author(s):  
Hanhee Bae ◽  
Sunyoung Kim ◽  
Byungsung Kim ◽  
Miji Kim ◽  
Jisoo Yang ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Short Form ◽  
Geriatric Depression Scale ◽  
Depression Scale ◽  
Case Finding ◽  
Community Dwelling ◽  
Cross Sectional

Mild cognitive impairment (MCI) and depression are common and frequently misdiagnosed in older adults in primary care. In particular, depression combined with cognitive dysfunction is associated with a higher risk of dementia. We tried to find the usefulness of orientation to time as an easy case-finding tool for suspecting MCI or depression. This cross-sectional study included 2668 community-dwelling adults aged 70–84 years from the Korean Frailty and Aging Cohort Study (mean age of 76.0 ± 3.9 years). MCI was defined based on the criteria from the National Institute on Aging and the Alzheimer’s Association; depression was defined as a score of ≥ 6 on the Geriatric Depression Scale—Short Form (GDS-SF). Time orientation to year, month, day of the week, date, and season were tested. The sensitivity for the diagnosis of each of MCI and depression was the highest for the orientation to year (MCI, 17.7%; depression, 16.0%). For the diagnosis of MCI or depression, orientation to the year had the highest sensitivity (15.5%), and the specificity, PPV, NPV was 95.5%, 67.0%, 65.5%. In conclusion, asking “what year is it?” can be helpful as an aid to case finding to suspect MCI or depression in community and primary care settings.

scholarly journals Predicting risk of undiagnosed COPD: development and validation of the TargetCOPD score

2017 ◽  
Vol 49 (6) ◽  
pp. 1602191 ◽  
Author(s):  
Shamil Haroon ◽  
Peymane Adab ◽  
Richard D. Riley ◽  
David Fitzmaurice ◽  
Rachel E. Jordan
Keyword(s):  
Primary Care ◽  
Electronic Health Records ◽  
Risk Score ◽  
Smoking Status ◽  
Cohort Analysis ◽  
Case Finding ◽  
Chronic Obstructive ◽  
Health Records ◽  
C Statistic ◽  
Electronic Health

Chronic obstructive pulmonary disease (COPD) is greatly underdiagnosed worldwide and more efficient methods of case-finding are required. We developed and externally validated a risk score to identify undiagnosed COPD using primary care records.We conducted a retrospective cohort analysis of a pragmatic cluster randomised controlled case-finding trial in the West Midlands, UK. Participants aged 40–79 years with no prior diagnosis of COPD received a postal or opportunistic screening questionnaire. Those reporting chronic respiratory symptoms were assessed with spirometry. COPD was defined as presence of relevant symptoms with a post-bronchodilator forced expiratory volume in 1 s/forced vital capacity ratio below the lower limit of normal. A risk score was developed using logistic regression with variables available from electronic health records for 2398 participants who returned a postal questionnaire. This was externally validated among 1097 participants who returned an opportunistic questionnaire to derive the c-statistic, and the sensitivity and specificity of cut-points.A risk score containing age, smoking status, dyspnoea, prescriptions of salbutamol and prescriptions of antibiotics discriminated between patients with and without undiagnosed COPD (c-statistic 0.74, 95% CI 0.68–0.80). A cut-point of ≥7.5% predicted risk had a sensitivity of 68.8% (95% CI 57.3–78.9%) and a specificity of 68.8% (95% CI 65.8.1–71.6%).A novel risk score using routine data from primary care electronic health records can identify patients at high risk for undiagnosed symptomatic COPD. This score could be integrated with clinical information systems to help primary care clinicians target patients for case-finding.

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