Routine Cognitive Screening Research Articles

Wisconsin Card Sorting Task-64 performance among HIV+ Black/African American and Latinx adults compared to normative samples and by sociocultural and health variables

Many people living with HIV experience cognitive impairment, and HIV disproportionately affects racial/ethnic minority groups. Independent of HIV, racial/ethnic minority individuals perform worse than White individuals on cognitive tasks, even after accounting for education. Our goals were to (1) compare WCST-64 scores between HIV+ Black/African American (Black/AA) (n = 45) and Latinx (n = 41) urban-dwelling adults; (2) compare our total sample to the WCST-64 manual’s normative (N) and clinical normative (CN) groups; and (3) explore relationships between WCST-64 performance and sociocultural/health variables. In our sample, employment (12%), mean annual income (<$10,000), and mean education (<12 years) were low, while mean medication adherence rates were high for both Black/AA (90%) and Latinx (87%). WCST-64 scores were similar between groups (p > .05). Percentages of “below average” and “mildly impaired” scores in our sample were higher than the N group, and similar to the CN group. Lifetime heroin use, dementia, and longer HIV illness duration were significantly associated with worse WCST-64 performance (ps < .05). The observed low scores in our asymptomatic sample are likely due to the intersectionality of sociocultural and medical burden, highlighting complexities in interpreting neuropsychological data in real-world HIV+ clinics. Executive deficits are linked to poorer outcomes, and routine cognitive screening may be clinically indicated.

Factors influencing routine cognitive impairment screening in older at-risk drinkers: Findings from a qualitative study in the United Kingdom.

Cognitive Impairment (CI) screening is recommended for those engaged in harmful levels of alcohol use. However, there is a lack of evidence on implementation. This paper explores the barriers and facilitators to CI screening experienced across a service specifically for older drinkers. The findings draw on data gathered as part of an evaluation of a multilevel programme to reduce alcohol-related harm in adults aged 50 and over in five demonstration areas across the United Kingdom. It is based on qualitative interviews and focus groups with 14 service providers and 22 service users. Findings are presented thematically under the section headings: acceptability of screening, interpretation and making sense of screening and treatment options. It is suggested that engagement with CI screening is most likely when its fit with agency culture and its purpose is clear; where service providers have the technical skills to administer and discuss the results of screening with service users; and where those undertaking screening have had the opportunity to reflect on their own experience of being screened. Engagement with CI screening is also most likely where specific intervention pathways and engagement practices can be accessed to respond to assessed need.

The educational impact of childhood-onset multiple sclerosis: Why assessing academic achievement is imperative

Background: Limited data suggest that adolescents with multiple sclerosis (MS) frequently discontinue school. While it is known that cognitive impairment occurs in 30% to 50% of children with MS, the functional impact of childhood MS on academic achievement is virtually unknown. Objective: To that end, this paper builds an evidence-based argument for evaluating educational outcomes in children with MS. Methods: This will be accomplished through (a) a review of pediatric MS and its cognitive consequences; (b) a selective review of the utility of neuropsychological batteries in assessing academic outcomes in pediatric populations in general; and (c) a brief overview of modifiable factors that have a potential benefit on school outcomes in children with MS. Conclusion: Scholastic achievement should be assessed as part of the routine cognitive screening of children and adolescents with MS.

Associations of functional, psychosocial, and medical factors with cognitive impairment in older, chemotherapy-naïve patients with early breast cancer.

12114 Background: Cognitive decline related to cancer and its treatments is a common concern among patients receiving treatment for cancer. Routine cognitive screening in oncology practice has been limited by the absence of a reliable, cancer-specific cognitive test. The Blessed Orientation Memory Concentration Test (BOMC) [1], has been incorporated in cancer-specific geriatric assessments, but there is no established cutpoint for cancer-related cognitive impairment. Recent research suggests that BOMC scores ≥ 5 may represent cognitive impairment in older patients with cancer. The purpose of this study was to identify cognitive impairment and associated characteristics in chemotherapy-naïve patients with breast cancer. Methods: Women with stage I-III breast cancer were recruited between 2009 and 2018. The BOMC (range 0-28, higher is worse function) was administered prior to chemotherapy. Associations between cognitive dysfunction (BOMC ≥ 5) and functional, psychosocial, medical variable were assessed using log binomial regression analysis. Results: In a sample of 331 women with breast cancer, the mean age was 65.2 years and 68.6% were 65 and older. Twenty-seven percent demonstrated cognitive impairment prior to treatment. Patients with Time Up and Go Test (TUG) ≥ 14 had increased risk of cognitive impairment compared to those with TUG &lt; 14 (44% vs. 23%, p = 0.0002). After controlling for demographic factors, the estimated increase in risk was 66% (RR: 1.66, 95% CI (1.20, 2.31), p = 0.002). For Medical Outcomes Survey (MOS) Physical Function, after controlling for demographic factors, each 1 point increase in physical function (range 0-20, higher is better function) was associated with a 5% decrease in risk of cognitive impairment (p = 0.0004). Conclusions: Using a newly proposed BOMC cutpoint of ≥ 5, our study identified cognitive impairment in over 25% of older, chemotherapy naïve women with breast cancer. This is similar to what has been reported using rigorous neuropsychological testing in comparable populations. Additionally, we found that this degree of cognitive dysfunction was associated with both patient-reported and clinician-assessed impairment in physical function, further supporting the clinical relevance of this new cutpoint. Reference: [1] Katzman et al. Am. J. Psychiatry. 140 (1983) 734–739.

Staging of cognitive impairment in Parkinson’s disease: validity of Quick Dementia Rating System

Purpose This study aimed to investigate the ability of the Quick Dementia Rating System (QDRS) to discriminate patients with PD who have mild cognitive impairment from those without cognitive impairment and those with dementia. Method A total of 105 patients with PD were classified as without cognitive impairment (N = 32), with mild cognitive impairment (N = 23), and PDD (N = 50), according to their score on clinical dementia rating. Multivariate regression analysis was performed considering age, education, and disease severity as covariates and mild cognitive impairment or dementia as outcome variables. Receiver operating characteristic curve analysis was carried out to derive the optimal cut-off points. Results The cut-off point >2.5 (sensitivity = 86.96%, area under curve (AUC) = 0.88) was obtained for discriminating patients with mild cognitive impairment from those without cognitive impairment based on the total score of QDRS. The cut-off point >5 (sensitivity = 84%, AUC = 0.84) was derived for discriminating mild cognitive impairment from dementia based on the total score of QDRS. Conclusions The results of this study showed a good discriminative validity of the QDRS for discriminating mild cognitive impairment from no cognitive impairment and dementia in patients with PD. IMPLICATIONS FOR REHABILITATION The Quick Dementia Rating System has a good discriminative validity for diagnosing mild cognitive impairment from normal cognitive function in Parkinson's disease. The Quick Dementia Rating System has a good discriminative validity for diagnosing mild cognitive impairment from dementia in Parkinson's disease. The Quick Dementia Rating System could be suggested as a routine rapid cognitive screening tool for patients with Parkinson's disease.

Discerning rural Appalachian stakeholder attitudes toward memory screening

ObjectiveThe aim of this descriptive study was to examine Appalachian stakeholder attitudes toward routine memory screening, and to compare and contrast results from a similar study conducted in an ethnically diverse rural Florida cohort. Determining perceptions about memory screening is essential prior to developing culturally relevant programs for increasing early dementia detection and management among rural underserved older adults at risk of cognitive impairment. Benefits of early detection include ruling out other causes of illness and treating accordingly, delaying onset of dementia symptoms through behavior management and medications, and improving long-term care planning (Dubois, Padovani, Scheltens, Rossi, & Dell'Agnello, 2016). These interventions can potentially help to maintain independence, decrease dementia care costs, and reduce family burdens (Frisoni, et al., 2017).MethodResearchers applied a parallel mixed method design (Tashakkori & Newman, 2010) of semi-structured interviews, measurements of health literacy (REALM-SF) (Arozullah, et al., 2007), sociodemographics, and cognitive screening perceptions (PRISM-PC) (Boustani, et al., 2008), to examine beliefs and attitudes about memory screening among 22 FL and 21 WV rural stakeholders (residents, health providers, and administrators).ResultsFindings included that > 90% participants across both cohorts were highly supportive of earlier dementia detection through routine screening regardless of sample characteristics. However, half of those interviewed were doubtful that provider care or assistance would be adequate for this terminal illness. Despite previous concerns of stigma associated with an Alzheimer’s disease diagnosis, rural providers are encouraged to educate patients and community members regarding Alzheimer’s disease and offer routine cognitive screening and follow-through.

Cerebrovascular Disease and Cognition in Adults with Sickle Cell Disease

Background: Sickle cell disease (SCD) is a genetic hematologic condition affecting more than 300,000 individuals worldwide. Most of the 100,000 individuals with SCD in the United States are African-American. An estimated 50% of those with the most severe genotype of SCD (HbSS) will have an overt or silent cerebral infarct (SCI) by age 30. While a significant number of studies have addressed the cognitive function and brain imaging of children with SCD, very few have included adults. As disease modification has increased over the last decade, a modern assessment of adults with SCD is needed. The aims of this study are to: 1. Determine the prevalence of cognitive impairment in adults with SCD 2. Determine if adults with SCD have deficits in functional task performance skills 3. Assess if and how cognitive function and task performance change over time Methods: This is a cross-sectional analysis of a prospective, observational cohort study. Adults, 18 years of age or older, with any form of SCD were recruited from the SCD clinics at Washington University in St. Louis. During baseline testing, participants completed the Wechsler Abbreviated Scale of Intelligence (WASI-II), National Institutes of Health Toolbox Cognition Battery (NIHTB-CB), and the Medication subtest of the Executive Function Performance Test (EFPT-M). The WASI-II and NIHTB-CB were repeated annually. Mean participant data from the baseline WASI-II and NIHTB-CB were compared with normative individual measure and composite scores using a one-sample t-test. The NIHTB-CB normative mean is a t-score of 50 with a SD of 10. Baseline results on Medication subtest of the EFPT were compared to previously tested control and stroke groups. Higher scores on the EFPT are indicative of greater executive dysfunction. Differences between Time 1 and Time 2 scores were evaluated using a paired-samples t-test. Univariate analyses were used to describe relationships between cognition and patient factors. Annual magnetic resonance imaging (MRI) was also conducted to assess infarct classification, with completion limited to 12-18 months from consent. Radiographical analyses were reviewed and recorded by the study neuroradiologists. Results: Forty participants were assessed at baseline; 9 completed Time 2 testing. Participant demographic information is presented in Table 1. Compared to the normative population, no significant differences were found on the WASI-II. On the NIHTB-CB, participants scored significantly lower on subtests measuring processing speed (Mean difference -13.8, p &amp;lt;.001), executive function (Mean difference -8.93, p = .001), attention (Mean difference -13.15, p &amp;lt; .001), working memory (Mean difference -5.68, p = .001), overall fluid cognition (Mean difference -13.08, p &amp;lt; .001), and total cognition (Mean difference -5.87, p = .002). Participants scored significantly higher than previously tested control (Mean difference 1.68,p &amp;lt;.001) and mild-stroke groups (Mean difference 1.18, p &amp;lt; .001) on the EFPT-M. Deficits in self-awareness were noted on all performance-based measures. No significant differences were found between participant means on Time 1 vs. Time 2 testing (Mean = 1.02 years, Range =.97-1.12). Participants with more severe phenotypes of SCD (HbSS or HbS-beta thal0) performed lower on the NIHTB test of attention when compared to those with HbSC (Mean difference -6.26, p=.039). History of stroke or use of disease modifiers had no relationship with cognitive outcomes. Of the 59 participants consented to yearly MRI evaluation, 45 have completed baseline imaging and 1 completed Time 2 imaging. Radiographical impressions reported: 1) overt strokes in 2 participants on transfusions (TF), 1 on hydroxyurea (HU), and 1 on no disease-modifying regimen (ND); 2) SCIs in 6 participants on TF, 6 on HU, and 4 on ND; 3) no infarct in 1 participant on TF, 18 on HU, and 9 on ND. Conclusion: Adults with SCD in this relatively highly educated cohort have marked deficits in executive function, attention, working memory, processing speed, and self-awareness. Cognitive deficits lead to difficulty completing everyday functional and disease-related activities, ranging from medication adherence to productivity in education and employment. Healthcare providers who treat individuals with SCD should be aware of the cognitive impairments in this population. Routine cognitive screening is needed to initiate referrals for cognitive rehabilitation. Disclosures King: Magenta Therapeutics: Membership on an entity's Board of Directors or advisory committees; Novimmune: Research Funding; RiverVest: Consultancy; Tioma Therapeutics (formerly Vasculox, Inc.):: Consultancy; WUGEN: Equity Ownership; Incyte: Consultancy; Amphivena Therapeutics: Research Funding; Cell Works: Consultancy; Bioline: Consultancy; Celgene: Consultancy.

Association Between Cognitive Impairment and Vitamin B12, Folate, and Homocysteine Status in Elderly Adults: A Retrospective Study.

Cognitive disorders in old age have a serious impact on the health and social aspects of patients and their families. The scope of this paper is to explore the role of cobalamin and folate that has been linked to cognitive decline, not only as a deficiency state depending on malnutrition, but also a determinant in cognitive impairment. A 6-year observational, retrospective study was conducted by collecting the routine blood analyses and cognitive screening scores of patients aged 60 years or older, followed at our Centre for the Diagnosis and Treatment of Cognitive Disorders. In a linear regression with a multi-vitamin model, higher folate concentrations were correlated with better cognitive performances through MMSE score, even after correction for sex, age, and years of education (beta = 0.144, p = 0.001). Estimated MMSE marginal means for folate versus homocysteine showed that folate deficiency was associated with worse cognitive performances, with a more severe cognitive impairment when hyperhomocysteinemia was present. The assessment of B-vitamin status among elderly adults can contribute to an economic and practical approach to the prevention and management of cognitive decline. Future studies focused to define optimal vitamin status are warranted.

Validity, reliability, and feasibility of the Brief School Needs Inventory: Evaluating educational risk for students with chronic health conditions.

Researchers have increasingly emphasized the need to include routine educational and cognitive screening in the care plan for youth with chronic health conditions. Prior to now, a screener did not exist to asses risk/need in education in the pediatric setting; thus, this research aimed to examine the validity, reliability, and feasibility of the newly developed Brief School Needs Inventory (BSNI), which stratifies a patients level of educational risk/need in the context of a health condition. The authors developed and pilot-tested two versions of an education risk screener utilizing a mixed-methods design, which included an expert panel review process and assessments for validity, reliability, and feasibility. Ninety-eight school-age survivors of an oncologic disease were assessed for educational risk. Participants were assigned to two groups and administered either the initial (n=48) or revised (n=50) version of the screener. The final version of the screener, the BSNI, predicted educational risk in congruence with school liaisons perceived risk assessment with 94% accuracy. Liaisons also reported confidence in the results of 98% of cases for the BSNI. Similarly, expert panel results for the BSNI indicated a high degree of interrater agreement and content validity. The BSNI was found to be a valid and reliable screener for predicting educational risk for youth with oncologic conditions; future studies will examine use of the screener within other pediatric chronic populations.

Predictors of Quality of Life among Older People with Mild Cognitive Impairment Attending Urban Primary Care Clinics

ABSTRACT Objectives To study the prevalence of Mild Cognitive Impairment (MCI) among older people attending primary care clinics and its predictors of QOL. Methods A cross-sectional study was conducted at two primary care clinics in Kuala Lumpur, Malaysia, recruiting 271 participants by utilizing the universal sampling method. Every patient who attended both the clinics during the study period and met the inclusion and exclusion criteria were approached and briefed about the study. Patients who gave consent were recruited as study participants. Information on sociodemographic, medical condition, and lifestyle behaviors were obtained. The Montreal Cognitive Assessment (MoCA) was used to screen for MCI at a score < 23. The World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire was used to evaluate QOL. Results Prevalence of MCI was 27.3%. Lower QOL scores were found in the physical (67.3 ± 1.4), psychological (67.3 ± 1.4), social (66.9 ± 1.6) and environmental (71.3 ± 1.3) domains among participants with MCI. Among them, predictors of QOL were depression in the physical domain, age and stroke in the psychological domain, presence of other types of disorders in the social domain and diabetes and stroke in the environmental domain. Conclusions MCI was prevalent among study participants and were associated with poorer QOL in all domains of QOL. A better understanding of predictors of QOL in older people with MCI is deemed important. Clinical implication Routine cognitive screening at primary care clinics will facilitate early recognition of MCI and facilitates referral to memory clinics for further assessment and treatment.

Implementation of Routine Cognitive Screening in the Preoperative Assessment Clinic.

Traditional systems of anesthesia evaluation do not routinely incorporate cognitive screening into preoperative assessments of vital organ systems. Increasing recognition of the importance of preoperative cognitive assessment of the elderly surgical patient has resulted in a "call to action" from experts in this area. A paradigm shift will be necessary to make this screening routine and not just a research tool. We describe our preliminary experience with developing a training program and implementing routine cognitive screening in a preoperative evaluation clinic. We outline a process showing our successful clinical implementation of sustainable cognitive stratification and documentation of routine cognitive screening.

Screening Positive for Cognitive Impairment: Impact on Healthcare Utilization and Provider Action in Primary and Specialty Care Practices.

Alzheimer's disease, the most common cause of dementia, goes unrecognized in half of patients presenting to healthcare providers and is associated with increased acute care utilization. Routine cognitive screening of older adults in healthcare settings could improve rates of dementia diagnosis and patterns of healthcare utilization. To evaluate the impact of screening positive for cognitive impairment on provider action in primary and specialty care practices and patient healthcare utilization. Individuals asymptomatic for cognitive impairment completed cognitive screening with the Mini-Cog (MC). Outcomes included MC screen-positive rates, provider follow-up actions, and healthcare utilization for all participants over a period of 36months (18months prior to and following MC screening). Data were extracted from the electronic medical record (EMR). Healthcare provider interventions and healthcare utilization for screen-positive and -negative groups, before and after screening, were compared. Primary and specialty care patients (n = 787) aged ≥ 65 without history of cognitive impairment seen in HealthPartners, an integrated healthcare system in Minnesota and Western Wisconsin. In primary care and neurology practices combined, over the entire 36-month study window, individuals screening positive showed 32% higher rates of ED visits (p < 0.05) pre and post-screening compared to those screening negative. Screen positive also showed 39% higher rates of hospitalizations pre-screening (p < 0.05) and 58% higher rates post-screening (p < 0.01). While screen-detected cognitive impairment was associated with some relevant provider follow-up action in 32% of individuals, subsequent healthcare utilization did not change between the 18-month pre- and post-screening periods. Despite being associated with higher rates of healthcare utilization, screening positive on the MC led to a change in provider action in a minority of cases and did not reduce post-screening healthcare utilization. Screening for cognitive impairment alone is not sufficient to alter patterns of provider practice or patient healthcare utilization.

An Appalachian Perspective of Alzheimer’s disease: A Rural Health Nurse Opportunity

Predictions of the devastating impact of Alzheimer’s disease (AD) are heightened in disadvantaged rural populations, yet studies investigating AD in this population are limited. Other researchers have shown that when rural Appalachian people are aware of their risk for a chronic illness, they are more willing to adopt healthy behaviors (Della, 2011; Schoenberg et al. 2011), suggesting that educational programs to increase knowledge and perception of risk are needed. The purpose of this article is to report findings from exploring knowledge of Alzheimer’s disease in a southern rural West Virginia community of residents (N = 193) and a sample of caregivers (n = 20) using cognitive interview techniques of “Think-aloud” and “Laddering”. The cultural fit and relevance of the “Knowledge of Alzheimer’s Disease scale or KAD (Jang, Kim, Hansen, &amp; Chiriboga, 2010) was also examined. Findings from the KAD included that an updated AD measure appropriate for use in rural settings is needed. Findings from the cognitive interview included that instead of fatalistic attitudes toward Alzheimer’s disease, residents often viewed AD as something potentially preventable through healthier living, use of herbs as children, and eventual discovery of more effective treatment regimens. The themes that emerged were “preventing AD” and “personal knowing of AD”. Considering cultural perceptions and determining knowledge gaps in the communities by rural providers is an important component of changing stigma regarding routine cognitive screening for rural older adults at increased risk for Alzheimer’s disease. DOI: http://dx.doi.org/10.14574/ojrnhc.v17i1.469

Postoperative cognitive dysfunction after cochlear implantation

Postoperative cognitive dysfunction (PCD) is a subtle, prolonged deterioration in cognition after surgery. This complication has been frequently investigated, mainly after major (cardiac) surgery. However, the incidence after cochlear implantation is unknown. Therefore, the aim of the study was to investigate the incidence and possible risk factors of PCD in severely hearing-impaired older adults after cochlear implantation. In a prospective cohort study, 26 older participants (age: M = 70, SD = 8years), scheduled for cochlear implantation, were assessed prior to and 1week after implantation by means of the Montreal Cognitive Assessment (MoCA). The incidence of PCD was calculated. In addition, the following possible risk factors were recorded: age, sex, education, duration of hearing impairment, preoperative signs of depression and anxiety, duration of anesthesia, anesthetic and surgical events and postoperative complications. The incidence of PCD was 11.5%, defined by a Z score of change in MoCA scores ≥1.96 (i.e., a decrease of ≥4 points). The incidence of PCD was corrected for practice effects by incorporating data from a reference group. Besides an effect of age on the postoperative cognitive performance, no significant risk factors were identified. The incidence of PCD after cochlear implantation is lower than after major surgeries, but higher than after other minor surgeries. Routine cognitive screening before and after cochlear implantation is recommended to identify patients with PCD and to provide additional care for these patients.

An Appalachian Perspective of Alzheimer's Disease: A Rural Health Nurse Opportunity.

Predictions of the devastating impact of Alzheimer's disease (AD) are heightened in disadvantaged rural populations, yet studies investigating AD in this population are limited. Other researchers have shown that when rural Appalachian people are aware of their risk for a chronic illness, they are more willing to adopt healthy behaviors (Della, 2011; Schoenberg et al. 2011), suggesting that educational programs to increase knowledge and perception of risk are needed. The purpose of this article was to report findings from exploring knowledge of Alzheimer's disease in a southern rural West Virginia community of residents (N = 193) and a sample of caregivers (n = 20) using cognitive interview techniques of "Think-aloud" and "Laddering". The cultural fit and relevance of the "Knowledge of Alzheimer's Disease scale or KAD (Jang, Kim, Hansen, & Chiriboga, 2010) was also examined. Findings from the KAD included that an updated AD measure appropriate for use in rural settings is needed. Findings from the cognitive interview included that instead of fatalistic attitudes toward Alzheimer's disease, residents often viewed AD as something potentially preventable through healthier living, use of herbs as children, and eventual discovery of more effective treatment regimens. The themes that emerged were "preventing AD" and "personal knowing of AD". Considering cultural perceptions and determining knowledge gaps in the communities by rural providers is an important component of changing stigma regarding routine cognitive screening for rural older adults at increased risk for Alzheimer's disease.

COGNITIVE SCREENING RESULTS FROM THE MEDICARE ANNUAL WELLNESS VISIT IN A PRIMARY CARE PRACTICE

Despite affecting 5.3 million individuals, Alzheimer's disease (AD) is often poorly recognized by healthcare providers until the moderate-severe stages. Cognitive screening is a potential strategy to better identify patients with undiagnosed or early stage dementia. Although the U.S. Preventative Services Task Force (USPSTF) does not recommend routine asymptomatic cognitive screening, the Medicare Annual Wellness Visit (AWV) provides an opportunity to utilize screening methods to identify populations with undiagnosed cognitive impairment (CI) and therefore, at greater risk for healthcare utilization. All patients undergoing cognitive screening with the MiniCog (MC) during a primary care Medicare AWV were identified. Data from the 18 months preceding screening were collected from the electronic medical record and included the MC score (0–5), demographics, healthcare utilization and presence of chronic disease (diabetes, hypertension, or hyperlipidemia). A MC score <4 was defined as screening positive for CI. Data analysis consisted of Poisson regression and normal mixed effects regression. A total of 5,084 patients (mean age 72.5 years; 46% male) underwent the MC during the AWV and 16.9% screened positive. Relative to those with normal MC scores, patients screening positive showed higher incidence rates of ER visits (80%), inpatient hospitalization (47%), and cancelled appointments (30%) during the 18 month preceding screening. The rate of MC screen positive was higher in diabetics compared to the non-diabetics (p=0.043). In addition, a greater number of hypertensive patients screened positive on the MC compared to the non-hypertensives (p=0.007). Finally, MC screen positive rate did not vary between populations with and without hyperlipidemia (p=0.485). The MC screen positive rate from the AWV was consistent with previous findings from the literature. Patients screening positive on the MC showed higher rates of healthcare utilization compared to those screening negative during the 18 months preceding MC administration. Hypertension and diabetes were associated with a greater risk of CI as detected by the MC. The AVW provides an unprecedented opportunity to identify early stage CI as well as patient populations at risk for higher healthcare utilization.

Abstract TMP45: Predicting Long-term Body Function, Activity &amp; Participation After Stroke: The Prevailing Role of Cognition in Determining Functional Outcome

Background: Stroke can impact multiple levels of function and result in complex disability. Few studies have examined limitations across the range of functions from body function to social participation, or explored the impact of post-stroke comorbidities, such as depression, obstructive sleep apnea (OSA) and cognition, on function, especially in the long-term. We aimed to determine post-stroke predictors of multiple levels of functioning approximately 2 years after a stroke, and to specifically evaluate the impact of depressive symptoms, OSA and cognitive impairment on outcome. Hypothesis: We hypothesized that in addition to traditional predictors of outcome–age and stroke severity–depression, OSA and cognitive impairment will predict functional outcome in multiple domains. Methods: Baseline assessment of depression, apnea and cognitive impairment with 2-year follow-up assessment of functional outcome to evaluate each of the three levels of functioning as stated in the WHO International Classification of Functioning: Body Function (Montreal Cognitive Assessment), Activity (modified Rankin) and Participation (Reintegration to Normal Living Index). Results: A total of 162 patients were enrolled at approximately 2 years and 5 months post-stroke. Forty one percent had activity limitations, 58% were cognitively impaired and 68% had restrictions in participation. Long-term activity limitation was predicted by greater age (OR = 0.95), stroke severity (OR = 1.69) and cognitive impairment (OR = 1.28) at baseline. Body function impairment was predicted by greater age (OR = 0.96), and cognitive impairment (OR = 1.49). Participation restriction was predicted by cognitive impairment (OR = 1.26). Conclusion: Baseline cognition predicts long-term function in multiple domains and is a better predictor of long-term participation than age or baseline stroke severity. In view of the widespread impact of post-stroke cognitive impairment on every level of functioning, routine post-stroke cognitive screening and target interventions are warranted. Greater attention to functional domains beyond activity could further optimize recovery and enhance outcome after stroke.

OUTCOMES FROM ROUTINE COGNITIVE SCREENING IN A HEALTH CARE SYSTEM

OUTCOMES FROM ROUTINE COGNITIVE SCREENING IN A HEALTH CARE SYSTEM

Routine cognitive screening in a neurology practice

Alzheimer disease is one of the most prevalent and costly neurologic disorders. American Academy of Neurology guidelines call for diagnosis and treatment when dementia is present, but provide no specific instruction relating to cognitive screening. Our center piloted a cognitive screening initiative using the Mini-Cog, which was administered to all neurology patients aged ≥70 years without a history of a cognitive disorder. There was a 37.4% screen positive rate on the Mini-Cog. The percentage of patients with subjective memory complaints did not differ between patients screening positive vs negative on the Mini-Cog. Prospective analysis over an 18-month postscreening period showed that individuals screening positive for cognitive impairment were 10 times more likely to have follow-up cognitive assessment by the provider (p < 0.0001), almost 3 times more likely to be referred for neuropsychological testing (p = 0.003), and 3 times more likely to receive a diagnosis of cognitive impairment or dementia (p < 0.0001) compared to those screening negative. Diagnosis of a cognitive disorder, referral to a cognitive specialty clinician, and prescription of cognitive-enhancing medications were no more frequent than was observed in a randomized trial of screening in primary care, and evidence of neurologists' actions relevant to cognitive impairment was found in a minority of individuals screening positive. Further studies are needed to better understand factors influencing neurologist actions in the evaluation and treatment of cognitive impairment.

Routine cognitive screening in older patients admitted to acute medicine: abbreviated mental test score (AMTS) and subjective memory complaint versus Montreal Cognitive Assessment and IQCODE.

Introduction: routine cognitive screening for in-patients aged ≥75 years is recommended, but there is uncertainty around how this should be operationalised. We therefore determined the feasibility and reliability of the Abbreviated mental test score (AMTS/10) and its relationship to subjective memory complaint, Montreal Cognitive Assessment (MoCA/30) and informant report in unselected older admissions.Methods: consecutive acute general medicine patients aged ≥75 years admitted over 10 weeks (March–May 2013) had AMTS and a question regarding subjective memory complaint (if no known dementia/delirium). At ≥72 h, the 30-point Montreal Cognitive Assessment (MoCA) and Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE) were done. Cognitive impairment was defined as AMTS < 9 or MoCA < 26 (mild impairment) and MoCA < 20 (moderate/severe impairment) or IQCODE ≥ 3.6.Results: among 264 patients (mean age/SD = 84.3/5.6 years, 117 (44%) male), 228 (86%) were testable with AMTS. 49/50 (98%) testable patients with dementia/delirium had low AMTS compared with 79/199 (44%) of those without (P < 0.001). Subjective memory complaint agreed poorly with objective cognitive deficit (39% denying a memory problem had AMTS < 9 (kappa = 0.134, P = 0.086)) as did informant report (kappa = 0.18, P = 0.15). In contrast, correlation between AMTS and MoCA was strong (R2 = 0.59, P < 0.001) with good agreement between AMTS < 9 and MoCA < 20 (kappa = 0.50, P < 0.01), although 85% of patients with normal AMTS had MoCA < 26.Conclusions: the AMTS was feasible and valid in older acute medicine patients agreeing well with the MoCA albeit with a ceiling effect. Objective cognitive deficits were prevalent in patients without known dementia or delirium but were not reliably identified by subjective cognitive complaint or informant report.