Abstract
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 specifically 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 significant 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 identified knowledge gaps to direct future research. Key learning points of the summit included: recognizing the importance of educating patients and healthcare providers about the value of assessing current and baseline cognition;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; andrecognizing the great potential, with appropriate caveats, of electronic health records to augment cognitive screening and tracking of changes in cognitive health over time. Summit Participants Deb Adler1, Christopher Alban, MD, MBA2, Mark Bondi, PhD3, Michelle Braun, PhD4, Xavier Cagigas, PhD5, Morgan Daven6, Robert L. Denney, PsyD7,8, Lisa Drozdick, PhD9, Norman L. Foster, MD10,11, Ula Hwang, MD12–15, Laurie Ivey, PsyD16, Grant Iverson, PhD7,17, Joel Kramer, PsyD18, Laura Lacritz, PhD7,19, Melinda Lantz, MD20, Lisa Latts, MD, MSPH, MBA21, Shari M. Ling, MD22, Ana Maria Lopez, MD23–26, Michael Malone, MD27,28, Lori Martin-Plank, PhD, MSN, MSPH, RN29, Katie Maslow, MSW30, Don Melady, MSc(Ed), MD31–33, Melissa Messer34, John Meyers, PsyD7, Charles E. McConnel, PhD19, Randi Most, PhD36, Margaret P. Norris, PhD37, William Perry, PhD7,85,39, Neil Pliskin, PhD40, David Shafer, MBA41, Nina Silverberg, PhD42, Tresa Roebuck-Spencer, PhD43,44, Colin M. Thomas, MD, MPH45, Laura Thornhill, JD46, Jean Tsai, MD, PhD10,47, Nirav Vakharia, MD48, Martin Waters, MSW49 Organizations Represented Alzheimer’s Association, Chicago, ILAMA/CPT Health Care Professionals Advisory Committee, Chicago, ILAmerican Academy of Clinical Neuropsychology (AACN), Ann Arbor, MIAmerican Academy of Neurology (AAN), Minneapolis, MNAmerican Association of Geriatric Psychiatry (AAGP), McLean, VAAmerican Association of Nurse Practitioners (AANP), Austin, TXAmerican Board of Professional Neuropsychology (ABN), Sarasota, FLAmerican College of Emergency Physicians (ACEP), Philadelphia, PAAmerican College of Physicians (ACP), Philadelphia, PAAmerican Geriatrics Society (AGS), New York, NYAmerican Psychological Association (APA), Washington, DCBeacon Health Options, Boston, MACanadian Association of Emergency Physicians, Ottawa, ON, Canada Collaborative Family Healthcare Association (CFHA), Rochester, New YorkGerontological Society of America, Washington, DCHispanic Neuropsychological Society (HNS), Los Angeles, CAIBM Watson Health, Denver, COInternational Federation of Emergency Medicine, West Melbourne, AustraliaInternational Neuropsychological Society (INS), Salt Lake City, UTNational Academy of Neuropsychology (NAN), Denver, COOptum of UnitedHealth Group, Minneapolis, MNPearson, New York City, New YorkPsychological Assessment Resources, Inc, Lutz, FLSociety for Clinical Neuropsychology, Washington, DCU.S. Department of Veterans Affairs, Washington, DC*Please note that participation in the Summit does not constitute organizational endorsement of this report
Highlights
The United States faces a dramatic demographic shift as its population ages, with important implications for health care delivery and costs (Miquel et al, 2017)
Age is a significant risk factor for many medical conditions, including cognitive impairment and dementia, and as the number of people over age 65 increases, the number of people living with these conditions will substantially increase (Prince, Comas-Herrera, Knapp, Guerchet, & Karagiannidou, 2016)
Cognitive impairment, which can be indicative of an acute condition, is often a precursor of dementia, a longer term condition involving the development of impaired cognitive function in multiple domains which has an impact on the individual’s daily life
Summary
William Perry, PhD, Laura Lacritz, PhD, Tresa Roebuck-Spencer, PhD, Cheryl Silver, PhD, Robert L. McConnel, PhD, Neil Pliskin, PhD, Deb Adler, Christopher Alban, MD, MBA, Mark Bondi, PhD, Michelle Braun, PhD, Xavier Cagigas, PhD, Morgan Daven, Lisa Drozdick, PhD, Norman L. MD, Ula Hwang, MD, Laurie Ivey, PsyD, Grant Iverson, PhD, Joel Kramer, PsyD, Melinda Lantz, MD, Lisa Latts, MD, MSPH, MBA, Shari M. MD, Ana Maria Lopez, MD, Michael Malone, MD, Lori Martin-Plank, PhD, MSN, MSPH, RN, Katie Maslow, MSW, Don Melady, MSc(Ed), MD, Melissa Messer, MHS, Randi Most, PhD, Margaret P. PhD, David Shafer, MBA, Nina Silverberg, PhD, Colin M. MD, MPH, Laura Thornhill, JD, Jean Tsai, MD, MPH, Nirav Vakharia, MD, Martin Waters, MSW, and Tamara Golden, PhD47
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