Screening For Cognitive Problems Research Articles

Screening and follow-up care for cognitive and emotional problems after transient ischaemic attack and ischaemic stroke: a national, cross-sectional, online survey among neurologists in the Netherlands

BackgroundAfter stroke, many patients experience cognitive and/or emotional problems. While national guidelines recommend screening for these problems, actual screening rates might be limited.ObjectiveThis study aimed to examine the clinical practice...

Single screening questions for cognitive impairment in older people: a systematic review

Single-item screening questions may be a practical first step in screening for cognitive problems in older people. A form of single-item cognitive assessment is proposed in the NHS England and Wales dementia strategy. We aimed to provide a review and synthesis of the evidence regarding the performance of single-item tests for detection of cognitive impairment. This review used Cochrane diagnostic test accuracy procedures. Two independent researchers searched for relevant papers across multiple, cross-disciplinary electronic databases using previously validated search strings. Our index test was any single screening question for cognitive impairment, including factor analysis of multi-item tools. Our reference standards included clinical diagnosis and multi-domain cognitive assessments. From 884 titles, 11 studies were identified as eligible for inclusion. Four studies were graded low risk of bias and recruited a representative patient sample. Five papers described a single screening question for cognitive impairment with each using a different question. Sensitivity ranged from 26 to 96% and specificity from 45 to 100%. Six papers described the component analysis of multiple item tools with broadly worded single questions ('decline in memory function', 'changes in ability to think and reason' or 'learning new things') performing best. Informant-based, single-item screening questions show promise for detecting cognitive impairment. However, there was substantial heterogeneity in format and application of single-item screens, and several studies were of poor methodological quality. Currently, there is insufficient evidence to support routine screening using a single-item approach.

32 * SINGLE SCREENING QUESTIONS FOR COGNITIVE IMPAIRMENT IN OLDER PEOPLE; A SYSTEMATIC REVIEW

Scope: Single item screening questions may be a practical first step in screening for cognitive problems in older people. A form of single item cognitive assessment is proposed in the NHS England and Wales dementia strategy. Our objective was to provide a review and synthesis of the evidence regarding the performance of single item tests for detection of cognitive impairment. Search methods: We performed a systematic review using Cochrane diagnostic test accuracy procedures. Two independent researchers searched for relevant papers across multiple, cross disciplinary electronic databases using previously validated search strings. Our index test of interest was any single screening question for cognitive impairment, including single items derived from factor analysis of multi-item tools. Our reference standards included clinical diagnosis (dementia, delirium and mild cognitive impairment) and accepted cut-offs on multi-domain cognitive assessments. We assessed risk of bias and external validity using the QUADAS-2 tool. Results: From 884 initial titles 11 studies were identified as eligible for inclusion in this review. Four studies were graded low risk of bias and recruited a representative patient sample. Clinical heterogeneity precluded formal meta-analysis. Five papers described a single screening question for cognitive impairment, each used a differing single question. Sensitivity ranged from 96% to 26%; specificity 45% to 100% depending on setting and question used. Six papers described component analysis of multiple item tools, in general broadly worded single questions around “decline in memory function”; “changes in ability to think and reason” or “learning new things” performed well. Conclusions: Informant based single item screening questions show promise for detection of cognitive impairment. However, there was substantial heterogeneity in format / application of single item screening tools and several papers had methodological or generalizability issues. Without further high quality test accuracy studies, we would not recommend large scale screening using a single item approach.

Activity and Life After Survival of a Cardiac Arrest (ALASCA) and the effectiveness of an early intervention service: design of a randomised controlled trial

BackgroundCardiac arrest survivors may experience hypoxic brain injury that results in cognitive impairments which frequently remain unrecognised. This may lead to limitations in daily activities and participation in society, a decreased quality of life for the patient, and a high strain for the caregiver. Publications about interventions directed at improving quality of life after survival of a cardiac arrest are scarce. Therefore, evidence about effective rehabilitation programmes for cardiac arrest survivors is urgently needed. This paper presents the design of the ALASCA (Activity and Life After Survival of a Cardiac Arrest) trial, a randomised, controlled clinical trial to evaluate the effects of a new early intervention service for survivors of a cardiac arrest and their caregivers.Methods/designThe study population comprises all people who survive two weeks after a cardiac arrest and are admitted to one of the participating hospitals in the Southern part of the Netherlands. In a two-group randomised, controlled clinical trial, half of the participants will receive an early intervention service.The early intervention service consists of several consultations with a specialised nurse for the patient and their caregiver during the first three months after the cardiac arrest. The intervention is directed at screening for cognitive problems, provision of informational, emotional and practical support, and stimulating self-management. If necessary, referral to specialised care can take place. Persons in the control group will receive the care as usual.The primary outcome measures are the extent of participation in society and quality of life of the patient one year after a cardiac arrest. Secondary outcome measures are the level of cognitive, emotional and cardiovascular impairment and daily functioning of the patient, as well as the strain for and quality of life of the caregiver. Participants and their caregivers will be followed for twelve months after the cardiac arrest.A process evaluation will be performed to gain insight into factors that might have contributed to the effectiveness of the intervention and to gather information about the feasibility of the programme. Furthermore, an economic evaluation will be carried out to determine the cost-effectiveness and cost-utility of the intervention.DiscussionThe results of this study will provide evidence on the effectiveness of this early intervention service, as well as the cost-effectiveness and its feasibility.Trial registrationCurrent Controlled Trials [ISRCTN74835019]