RISK STRATIFICATION AND COGNITIVE SCREENING: PREPARING FOR ALZHEIMER’S DISEASE-MODIFYING MEDICATIONS

Abstract

When a disease-modifying therapy for Alzheimer's disease (AD) becomes available, many researchers and industry leaders believe that the U.S. health care system will lack the capacity to provide patients with access to treatment within a reasonable timeframe. Access to care begins with effective identification of those patients appropriate for disease-modifying treatment. Risk stratification capacity can be expanded by employing validated cognitive self-assessments in the home setting, enabling patients to bring screening data to their health care professionals. Utilizing cognitive self-assessment screens as a first step toward effective risk stratification has potential to identify older adults who would benefit from a disease-modifying treatment. However, few self-assessments have been validated that are sensitive to mild cognitive impairment (MCI) or early AD. We conducted a national online survey of geriatric health care professionals on the potential use of self-assessment cognitive screening for MCI and AD to address these future health care needs. Next, we developed a rapid self-assessment screen (myMemCheck) designed for older adults who have concerns about their cognitive function. The psychometric properties of this instrument were investigated in two separate Maryland, USA nursing home and assisted living samples (Study 1, N = 63; Study 2, N = 200). The instrument evidenced adequate reliability and strong construct validity across both studies. Receiver operating characteristic analysis yielded an optimal cut score for identifying older adults with MCI or early AD. We discuss implications of using a reliable and valid self-assessment for determining whether a comprehensive test or evaluation for MCI or AD is indicated. Wider detection of MCI and AD by accurate at-home cognitive self-assessments could reduce the screening burden on primary care physicians.