http://www.alzheimers-illinois.org/enewsletter/february2013/care_doctors.asp
The Alzheimer’s Association® recently released guidance to help health care providers detect cognitive impairment as part of the Medicare Annual Wellness Visit.
Prior to this publication, there has been no comprehensive guidance on how to assess for cognitive impairment in the primary care setting. The recommendations include tools for patients and family members as well as an emphasis on vital patient history, self-reported concerns and clinician observations.
The Alzheimer’s Association® recently released guidance to help health care providers detect cognitive impairment as part of the Medicare Annual Wellness Visit.
Prior to this publication, there has been no comprehensive guidance on how to assess for cognitive impairment in the primary care setting. The recommendations include tools for patients and family members as well as an emphasis on vital patient history, self-reported concerns and clinician observations.
Detecting possible cognitive impairment is the first step in determining whether or not further evaluation is needed. In developing the recommendations, the Alzheimer’s Association convened a group of experts to survey the current literature and build consensus around an effective, practical and easy process. For more information on the recommendations, click here.
“We understand that by assessing and documenting cognitive status on an annual basis during
the Annual Wellness Visit, clinicians can more easily monitor gradual cognitive decline in a
patient over time,” said Bill Thies, Ph.D., Alzheimer’s Association chief medical scientific officer.
According to the Alzheimer’s Association’s 2012 Alzheimer’s Disease Facts and Figures report, among the more than 5 million Americans with Alzheimer’s disease, as many as half have not been diagnosed. Without initial detection, these individuals would not be diagnosed which would deprive them of available treatments and services as well as the opportunity to make financial and care plans.
“Widespread use of the steps identified by the Alzheimer’s Association Medicare Detection of Cognitive Impairment Workgroup could make significant inroads in reducing the prevalence of missed or delayed dementia diagnosis by either establishing a baseline for cognitive surveillance
or a trigger for further diagnostic evaluation,” Thies added.
In addition to the range of tools identified, the recommendations offer suggested questions to include in the required Health Risk Assessments that patients must provide for the visit. The recommendations include tools that are available in multiple languages and are unaffected by
levels of education or different cultural backgrounds.
While the Workgroup emphasizes in its recommendations “no one tool is recognized as the best brief assessment to determine if a full dementia evaluation is needed,” several tools were found most suited for assessing cognitive impairment at no cost to the health care provider during the visit.
These include the Mini-Cog™, the Memory Impairment Screen (MIS), and the General Practitioner Assessment of Cognition (GPCOG). Positive attributes of these tests are that they were relatively free of education, race or cultural bias and take five minutes or less to administer – a very
favorable aspect given the often limited time primary care physicians have per patient. Recognized tools suited for those close to the patient such as spouses, family members or friends were the AD8, the Short Informant Questionnaire on Cognitive Decline in the Elderly (short IQCODE), and the Informant GPCOG.
The Alzheimer’s Association looks forward to working with physician organizations and
government agencies as it works to share these recommendations.
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