Early detection makes a difference
Annual screening of cognitive and functional status leads to early detection and early action.
It all starts with detection.
The earlier we detect dementia, the better. It helps with getting on the right track for evidenced-based care: timely medical interventions, personalized care plans, and supporting caregivers. And it allows us to start brain health interventions that slow the progression of dementia as early as possible.
Screening, or a brain health check, with your older patients every year can be simple. Scroll down to see a step-by-step approach for detection.
The foundation is understanding your patient’s cognitive and functional status. Are there any signs of cognitive decline or functional decline from a previous baseline? Those two elements are the core components of a dementia diagnosis. Another foundational aspect of care is knowing if there is a caregiver, how they support the person with dementia, and their needs as a caregiver.
Steps for screening
Screen adults 65 and older who do not already have a diagnosis of dementia and who are not on hospice.
Use an approach that quickly assesses cognition, function, and caregiver support. One example is called the “cognitive health assessment”, which has 3 steps:
- Ask about symptoms or review signs of cognitive decline in the last year.
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Do a brief test on cognition and function. An informant can complete all or part of this assessment. Examples:
Example 1- A Mini-Cog and an ADL/IADL checklist with the patient.
Example 2- A GP-COG page 1 with the patient and GP-COG page 2 done with an informant.
There is information on Dementia Care Aware's Tips to Adjust the Cognitive Health Assessment on how to adapt assessments to a patient's needs, such as language consideration, sensory loss, and educational level.
- Ask if there is a caregiver and document their role.
Disclosure: Inform your patient of the results of their screen.
Example: "On this brief evaluation, there were some signs that you may be having changes in your {thinking/ability to take care of daily tasks}. Let's make a brain health plan and follow-up soon to keep looking into this."
Plan follow-up:
- If a patient has a positive screen, then plan a follow-up appointment to go further in their evaluation and start a brain health plan. See Diagnosis for next steps.
- If a patient has a negative screen, then plan to screen again next year.
Increasingly, there is evidence of the benefits of early interventions, such as increased social activity and correcting hearing. If a patient has a positive screen, there are steps you can take to support brain health:
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Assess and correct hearing and vision.
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Encourage physical and social activity.
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Remove any medications that can affect cognition (for example, sedative-hypnotics and anticholinergics).
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One tool, the ACBcalc.com, can quantify cholinergic burden with a particular medication regimen.
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Optimize their lipid, hypertension, and diabetes management.
See this summary. And here are additional resources from Dementia Care Aware and the Brain Health Toolkit on how to create a brain health plan.
Did you know?
Correcting hearing loss can prevent dementia and help slow cognitive decline by 30%.
The sooner we detect cognitive symptoms, the sooner we can prioritize hearing.