MemoryCare Offers Education on Using Dementia Screening Tools in the Primary Care Setting
An important part of our mission at MemoryCare is to provide community and professional education about Alzheimer’s disease and other cognitive disorders. Our staff physician, Dr. Thomas Kaluzynski, developed a teaching module on utilizing three brief screening tools (the AD8 Dementia Screening Interview, the Mini-Cog and the Time and Change Test) in the primary care setting. The project was made possible through Opportunity Grant funding from the Community Foundation of Western North Carolina.
Dr. Kaluzynski, together with Misty Haire, RN, one of MemoryCare’s care managers, developed the educational module through a series of live presentations conducted at primary care practice sites. Participants completed a follow-up survey on their own success in incorporating the screening tools in their primary care practice sites: 100% of the surveyed participants reported they became more familiar with the screening tools and 84% reported they have incorporated use of one or more of the screening tools in their practice as a result of this project.
Each tool is designed to take less than five minutes to administer. The goal of the DVD teaching module is to demonstrate how such tools can be very useful when a primary care provider has very little time but needs to respond to the real concerns that patients and family members bring to the office about a decline in a patient’s cognitive abilities. The educational DVD with demonstrations of each test is available through our office and copies of the screening tools can be downloaded from this page of our website.
In the DVD, Dr. Kaluzynski points out that whether or not one agrees with the USPSTF (United States Protective Services Task Force) conclusion that the evidence is insufficient to recommend for or against general screening for dementia in the older adult, clinical experience provides substantive evidence that AT RISK individuals can be diagnosed in the earliest stages of dementia. When such early diagnosis is made, then potentially reversible or modifiable risk factors contributing to a decline in cognitive function can be investigated and treated. Early diagnosis also reduces the patient’s safety risk for issues with proper management of other medical disorders, medications, nutrition, driving, and financial vulnerability. Whether cognitive impairment is suspected based on direct observation, patient report, or concerns raised by family members or others knowledgeable about the person’s prior level of function, further evaluation is essential.
Each of these brief screening tools is basic enough that with minimal practice, it can be administered by office staff. The AD8 Dementia Screening Interview can be completed by a family member or other close informant prior to the visit. Concerned family members are encouraged to download the AD8 interview form from this site, complete it, and take it to their loved one’s primary care provider. Studies have demonstrated that this simple and brief tool is a valid and reliable screen for distinguishing individuals with very mild dementia from those without dementia. Two or more positive responses are considered an abnormal screen and strongly correlate with the likelihood that the individual of concern has cognitive impairment.
In a nutshell here are the points stressed in the DVD:
The most common misdiagnosis of mild cognitive impairment is normal aging.
Recent studies in primary care practices have found rates of undetected dementia between 50 and 66 %.
No single screening instrument is ideal for all settings.
Experts in dementia screening and case finding consistently emphasize that in the case of cognitive difficulties, it is MANDATORY to try to obtain collateral information from a knowledgeable informant.
Following the advice published in the JAMA article entitled “Does This Patient Have Dementia?” (Holsinger, T et al., JAMA June 6, 2007; 297:2391-2404), picking one screening tool that is population appropriate and considering adding one or two others for special situations should be an efficient and effective practice for the busy primary care provider.
Although the Mini-mental Status Exam is the one of the best studied instruments of cognitive impairment, it takes 7 to 10 minutes to deliver and when it is used in unselected patients its predictive value for identifying someone with dementia is only fair. It lacks the sensitivity and specificity in detecting very mild dementia.
If initial screening tests are negative and mild cognitive impairment is suspected in a highly educated or high functioning individual, referral for more detailed neuropsychological testing to appropriately evaluate the patient may be necessary.
In summary, the DVD covers the AD8 Dementia Screening Interview, the Mini-Cog, and the Time and Change test – brief screening tools which when combined with the narrative history of the patient’s memory concerns help to identify those patients who need further diagnostic work up. They are brief enough to fit into a routine office visit by either the physician or an office nurse or assistant.
Please contact our office if you would like to receive a copy of this educational DVD. Our staff care managers who are familiar with administering the screening tests reviewed are available to assist your staff with specific questions related to screening. Likewise our staff physicians, Dr. Peggy Noel, Dr. Ginna Templeton, and Dr. Tom Kaluzynski are available to provide more information. We are especially grateful to the Community Foundation of Western North Carolina for making this project possible.
Educational Workshop on Dementia Screening in the Primary Care Setting:
To View or copy the screening tools click on the appropriate button:
The AD8 Dementia Screening Interview
The Mini-Cog
The Time and Change Test
A Limited supply of the video recording of the workshop presented by MemoryCare staff physician Dr. Tom Kaluzynski and Misty Haire, RN is available- please call the MemoryCare office at 828-771-2219 to find out if a DVD copy is available and/or if you would like a copy of the materials with a reference list related to the screening tools covered in the workshop.
