Is it possible to implement standard neuropsychological assessment in European memory clinics? An EADC‐ISTAART survey

Abstract

AbstractBackgroundNeuropsychological assessment of mild cognitive impairment (MCI), a gateway for the biomarker‐based diagnosis, should follow a standard operating procedure to enhance the reliability of clinical diagnosis across centers and decrease costs to both patients and health‐care systems. A previous consensus adapted the NACC UDS‐3 for use in European memory clinics (cUDS). Here, we assess its implementability.MethodClinicians from the European Alzheimer’s Disease Consortium (EADC) memory clinics answered an online semi‐structured survey investigating center practices, potential hurdles and facilitators to implement the cUDS. We performed descriptive statistics and content analysis of explanatory comments to investigate the nature and frequency of perceived hurdles and facilitators.ResultFifty out of the 69 EADC memory clinics (72%) answered from 17 countries: 7 Northern, 22 Western, 4 Eastern and 17 from Southern Europe, with heterogeneous national participation (range: 1‐8 centers per country) (Figure).Centers have a variable yearly patient flow (range: 100‐2500), use heterogeneous definitions of MCI and cognitive batteries, and offer variable proportions of neurology (86%), psychology (80%), psychiatry (64%) and geriatrics (62%) services.Thirty‐three centers (66%) expressed propensity to implement the cUDS. Six of the twelve cUDS tests are already frequently used: e.g, the fluency tests are used in 87‐100% of the assessments. Up to 9 of the 12 tests have local norms in different countries, although not systematically. Hurdles for the 17 EADC responders (34%) not inclined to implement the cUDS are organizational‐logistical (7/13 providing explanations) relative to time‐management issues and need for clinicians training, cultural barriers and resistances to change ongoing practices (6/13). Among the latter, availability of previous local harmonization (Germany, Netherlands, Spain, Switzerland and United Kingdom) appears the strongest motive, followed by a preference for patient‐tailored assessment. Economic factors did not seem to hinder implementation, 90% of the centers not in favor having 61‐100% refund for cognitive assessment.ConclusionDespite barriers, our preliminary data denote propensity to standardize neuropsychological assessment. The involved centers of excellence may be not fully representative, especially relative to non‐academic contexts. Next steps may require to collect more detailed information, also from non‐academic clinics, and identify specific country and context requirements.