In December 2017, the National Academy of Neuropsychology convened an interorganizational Summit on Population Health Solutions for Assessing Cognitive Impairment in Geriatric Patients in Denver, Colorado. The Summit brought together representatives of a broad range of stakeholders invested in the care of older adults to focus on the topic of cognitive health and aging.
Summit participants speci?cally examined questions of who should be screened for cognitive impairment and how they should be screened in medical settings. This is important in the context of an acute illness given that the presence of cognitive impairment can have signi?cant implications for care and for the management of concomitant diseases as well as pose a major risk factor for dementia.
Participants arrived at general principles to guide future screening approaches in medical populations and identi?ed knowledge gaps to direct future research. Key learning points of the summit included:
1. Recognizing the importance of educating patients and healthcare providers about the value of assessing current and baseline cognition;
2. Emphasizing that any screening tool must be appropriately normalized and validated in the population in which it is used to obtain accurate information, including considerations of language, cultural factors, and education; and
3. Recognizing the great potential, with appropriate caveats, of electronic health records to augment cognitive screening and tracking of changes in cognitive health over time.
Identification of “At Risk” Patients: The Role of Registries and What Occurs When a Person Tests Positive on a Screen
The objective of screening for cognitive impairment is to improve patient care and outcomes for people with cognitive difficulties. The group emphasized that screening is not diagnostic; it provides important information to the clinician to make informed decisions and to consider next step pathways.
Ultimately the goal of screening is to lead to improved patient care. In turn, screening combined with additional sources of information can lead to identifying remediable causes of cognitive impairment that can be medically addressed; transition planning that can better ensure patient safety and adherence to recommended treatment or follow up care; reduction in hospital, PCP, and ED use; and finally provide education, planning, and support to the patient and family/caregiver to improve quality of life.
Identifying “at risk” patients differs depending on the medical setting. In the ED, the primary goal may be to identify risk to prevent, recognize, and treat delirium. In this setting, the patient may be best assessed by a primary ED nurse and if delirium is identified, a pathway including evaluating underlying causes and deploying a care plan can be pursued. If there is a history of cognitive impairment or cognitive complaints, a delirium prevention protocol can be implemented.
In the primary care setting, the primary goal may be to optimize adherence to personalized care plans. Assessment may occur during the AWV or next care visit based on risk factors or response to brief targeted questions.