Why experts are of two minds about the value of cognitive screening.
Almost 6 million Americans have Alzheimer’s disease, and just about everyone over 65 has at least some fear of getting it.
The first step in finding out if any dementia – and Alzheimer’s is a terrible form of dementia – is a cognitive screening.
Cognitive screenings, such as the Mini-Cog, Memory Impairment Screen, General Practitioner Assessment of Cognition, Mini-Mental Status Examination, and the Montreal Cognitive Assessment, take five to ten minutes. They involve doctors asking patients with no obvious symptoms of mental decline to recall words, draw a clock face, spell a word backward, remember a sequence of words, and similar tasks.
Since seniors have a higher risk of Alzheimer’s, memory or thinking problems, or other cognitive impairment, does periodic cognitive screening make sense? The answer depends on which experts you ask.
The US Preventive Services Task Force, whose recommendations help shape Medicare and Advantage Plan policies, spent months deliberating this question. In late February, they announced the result: a hung jury. Pending more studies of cognitive screening’s benefits and downsides, they announced, the task force could neither endorse nor oppose it.
Doctors – and their patients – seem just as ambivalent.
Multiple studies show that at least half the time, physicians routinely overlook or fail to recognize forms of dementia in seniors. In a 2018 Alzheimer’s Association survey of 1,954 seniors, only 16 percent said physicians regularly checked patients’ cognition.
As for the patients – well, even though Medicare has required doctors to assess patients’ cognition during the free annual wellness visit, only 19% of seniors scheduled annual wellness visits.
Clinical psychologist Dr. Stephen Rao, of the Cleveland Clinic’s Lou Ruvo Center for Brain Health, says that cognitive screening “can start a discussion with your doctor,” which will lead to follow-up. On the other hand, University of Florida College of Medicine professor Benjamin Bensadon worries that, “Getting a positive result can make someone wary about their cognition and memory for the rest of their life.”
Another gray area is that while cognitive screenings can show that something may be wrong, they can’t show what that something is. A diagnosis can. But with shortages of geriatric psychiatrists, geriatricians, neuropsychologists and neurologists, waiting lists can run as long as six months.
So it’s not surprising that in a year-ling Indiana University study, two-thirds of seniors who tested positive for cognitive impairment chose to forgo further evaluation. But should they have?
About 10% of cognitive difficulty treating their causes can potentially reverse cases. These include sleep apnea, vision or hearing loss, vitamin B12 or folic acid deficiency, alcohol abuse, and drug side effects.
Both the American Diabetes Association and the American Academy of Neurology recommend that older patients with diabetes, or those being seen by a neurologist get annual screenings for overlapping cognitive conditions.
And the American College of Surgeons urges older patients to be screened before undergoing surgery. A preexisting but unknown cognitive impairment can heighten the risks of sudden-onset delirium, which the right medical condition can prevent or mitigate.
This is why a detailed three-part needs assessment is the basis of our holistic senior care management, and why the mental status is such an important part of it. Since many people can have cognitive impairment without noticing, we make sure to interview family members as well. It’s also why we coordinate with the doctors and make sure any changes they recommend become part of the everyday care regimen.
Cognitive screenings are free, quick, painless and sometimes necessary to prevent worse problems. According to Dr. David Reuben, past president of the American Geriatrics Society, “A substantial number of patients with mild cognitive impairment – about 50% – don’t develop dementia within five years of being diagnosed.”
To see what a difference holistic senior care can make, please call or contact us to arrange a comprehensive consultation.