What tools are being be used and are
patients being screened and diagnosed?
Maggie Heidenreich
 Defined
as, “a general term that describes a
group of symptoms—such as loss of memory,
judgment, language, complex motor skills,
and other intellectual function—caused by
the permanent damage or death of the
brain's nerve cells, or neurons.”
(Alzheimers Foundation of America,
2013)
 5.6
million people suffering from dementia in
the U.S. (Alzheimer’s Association, 2012)
 6th leading cause of death in the U.S. (Alzheimer’s
Association, 2012)
 Estimated
1 in 7 (Alzheimer’s Association, 2012)
 No prevention, no cure
 Costs $200 billion (Alzheimer’s Association, 2012)
 Costs
$20,000 per patient per year
(Zhu, Scarmeas,
Torgan, Albert, Brandt, Blacker, et al., 2006)
 Increases
as disease progresses (Zhu, et al., 2006)
 Costs made as estimation of work time lost
for caregivers (Zhu, et al., 2006)
 Time spent for care giving ranges (Zhu, et al., 2006)
 Long term care facilities are expensive (Duru,
Callahan, Unverzagt, Weiner, Beck, et al., 2009).
 Misdiagnosed (Boustani, et al., 2006)
 Devastating
to patient and family
 Diagnosis not made until later stages
 Goal is detection and planning

Alzheimer’s Association and NIH Guidelines
(2011)
Biomarkers for diagnosis in future
 Find MCI




Look for changes in cognition
Diagnostic tests
American Academy of Neurology (2003)
Recommends use of different diagnostic tools not
biomarkers
 Watch the MCI
 CT scan

(Jack, C.R., Albert, M.S., Knopman, D.S., McKhann, G.M., Sperling, R.A., Carillo, M.A., et al., 2011, AGS Clinical Practice Committee, 2003)
 Institutional
reviews, cross-sectional designs,
experimental designs, meta analysis, and
prospective designs were all reviewed
 Results
of review found some problems with
dementia screening
 Problems:

Medical students receiving inadequate training
on dementia management (Mitchell, A.J., Meader, N., Pentzek, M., 2011)

People refuse screening (Boustani, Perkins, Fox, Unverzagt, Austrom, et al., 2008)
(Justiss, Boustani, Fox, Katona, Perkins, Healey, et al., 2009)

Practitioners are not always able to recognize
the disease and do not always document mental
changes (Mitchell, A.J., Meader, N., Pentzek, M., 2011)

Many barriers to effective care of dementia in
primary care offices
(Hilton, Franz, Reddy, Flores, Kravtiz, et al., 2007)
 Tools

Review of research found that…

AD8 over MMSE
(Kamenski, G., Dorner, T., Beng, K.T., Psota, G., Rieder, A., Schwarz, F., et al, 2009; Galvin,
Fagan, Holtzman, Mintun, Morris, 2009)

MMSE and Mini-cog (Kamenski, Dorner, Beng, Psota, Rieder, et al., 2009; Holsinger, Plassman,
Stechuchak, Burke, Coffman, et al., 2012, Crum, Anthony, Bassett & Folstein, 1993)

Comparing the Iqcode, FAQ, MMSE
Sanz, et al., 2011)
(Cruz-Orduna, Bellon, Torrero, Aparicio,
 In
a primary care office in Northeast Ohio,
how many patients are screened for
dementia, what tool is used, and is there
correct documentation of the results?
 Chart
data review
 Primary care office in Northeast Ohio
 Only demographic, presence of test, and
diagnosis will be reported
 Sample

Inclusion



65 yrs and older
Male and female
Exclusion


Cognitive impairment
Non-English speaking
Sex
26%
Female
Male
74%
Ages of Subjects
18
16
14
12
10
Ages of Subjects
8
6
4
2
0
62-75
76-85
85-95
1
out of 35
 MMSE
 Documentation
 Dementia
screening is not routinely done
 Mini Cog and MMSE specific and sensitive for
picking up dementia characteristics in
primary care settings
 Healthcare professionals need more
education regarding dementia management
and resources for effective treatment
 More education to patients regarding
importance of screening
 There




are several limitations to this study:
small sample size
convenience sample
only one office used
not a representative sample
 The
data shows that very few people are
being screened for dementia using any tool
 Although guidelines exist, they do not outline
an age or frequency of screening
 Need further research





AGS Clinical Practice Committee. (2003). Guidelines abstracted
from the American academy of neurology’s dementia guidelines
for early detection, Diagnosis, and management of dementia.
The American Geriatrics Society. (51), 869-873
Albert, M.S., DeKosky, S.T., Dickson, D., Dubois, B., Feldman,
H.H., Fox, N.C., et al., (2011). The diagnosis of mild cognitive
impairment due to Alzheimer’s disease: Recommendations from
the National Institute on aging-Alzheimer’s association
workgroups on diagnostic guidelines for Alzheimer’s disease.
Alzheimer’s Association. (2012). Alzheimer's facts and figures.
Retrieved from
http://www.alz.org/alzheimers_disease_facts_and_figures.asp.
Alzheimer’s Foundation of America. (2013). About Dementia.
Retrieved from
http://www.alzfdn.org/AboutDementia/definition.html.
Boustani, M., Perkins, A. J., Fox, C., Unverzagt, F., Austrom, M.
G., & Fultz, B., et al. (2006). Who refuses the diagnostic
assessment for dementia in primary care?. International Journal
of Geriatric Psychiatry, (21), 556-563. doi: 10.1002/gps.1524




Crum, R.M., Anthony, J.C., Basset, B.B., & Folstein, M.F. (1993).
Population-based norms for the mini-mental state examination by
age and education level. Journal of the American Medication
Association. 269(18). Retrieved From
http://faculty.pepperdine.edu/shimels/Courses/Files/MMSE.pdf.
Cruz-Orduna, I., Bellon, J.M., Torrero, P., Aparicio, E., Sanz, A.,
et al. (2011). Detecting mci and dementia in primary care:
Efficiency of the MMS the FAQ and the IQCODE. Family Practice.
29, 401-406. DOI: 10.1093/fampra/cmr114.
Galvin, J.E., Fagan, A.E., Holtzman, D.M., Mintun, M.A., &
Morris, J.C. (2010). Relationship of dementia screening tests with
biomarkers of alzheimer’s disease. Brain. 133, 3290-3300. DOI:
10.1093/brain/awq204.
Hilton, L., Franz, C.E., Reddy, G., Flores, Y., Kravitz, R.L., et al.
(2007). Practice constraints, behavioral problems, and dementia
care: Primary care physicians’’ perspectives. Journal of General
Internal Medicine. 22(11), 1487-1492. Retrieved from
http://ezproxy.uakron.edu:3130/ehost/pdfviewer/pdfviewer?sid
=97b96b0a-b5bc-41ad-80b8126f079256da%40sessionmgr11&vid=37&hid=27.




Holsinger, T., Plassman, B.L., Stechuchak, K.M., Burke, J.R.,
Coffman, C.J., et al. (2012). Screening for cognitive impairment:
Comparing the performance of four instruments in primary care.
The American Geriatrics Society. 60, 1027-1036.
Jack, C.R., Albert, M.S., Knopman, D.S., McKhann, G.M.,
Sperling, R.A., Carillo, M.A., et al., (2011). Introduction to the
recommendations from the National Institute on agingAlzheimer’s Association workgroups on diagnostic guidelines for
Alzheimer’s disease. The Alzheimer’s Association.
Justiss, M.D., Boustani, M., Fox, C., Katona, C., Perkins, A.J.,
Healey, P.J., et al., 2009. Patients’ attitudes of dementia
screening across the Atlantic. International Journal of Geriatric
Psychiatry. 24. 632-637.
Kamenski, G., Dorner, T., Beng, K.T., Psota, G., Rieder, A.,
Schwarz, F., et al. (2009). Mini-Cog assessment with the mental
state examination. Mental Health in Family Practice. 6(4), 209217. Retrieved from
http://ezproxy.uakron.edu:3130/ehost/pdfviewer/pdfviewer?sid
=97b96b0a-b5bc-41ad-80b8126f079256da%40sessionmgr11&vid=33&hid=109.

Mitchell, A.J., Meader, N., Pentzek, M., (2011). Clinical
recognition of dementia and cognitive impairment in primary
care: a meta-analysis of physician accuracy. Acta Psyhiatr Scand.
124, 165-183. DOI: 10.1111/j.1600-0447.2011.01730.x.

Saira, B., Moss, S.B., Nair, R., & Tingle, L. (2010). Practice
patterns in the evaluation and management of dementia by
primary care residents, primary care physicians, and
geriatricians. Baylor University Medical Center. 23(2). 121-125.

Zhu, C.W., Scarmeas, N., Torgan, R., Albert. M., Brandt, J.,
Blacker, D., et al., (2006). Clinical characteristics and
longitudinal changes of informal cost of alzheimer’s disease in
the community. The American Geriatrics Society. 54, 1596-1602.