Brandy R. Matthews, MD

More than half of community-dwelling elders with dementia had no reported history of clinical cognitive evaluation.

Although recent guidelines emphasize the lack of evidence that routine screening for dementia alters patient and caregiver decision making, other data suggest that cognitive evaluations may improve short-term functional outcomes and cost-effectiveness of care. In this study, a consensus panel of experts including neurologists, neuropsychologists, geropsychiatrists, and internists diagnosed dementia in 297 of 844 individuals aged ≥70 years from a nationally representative, community-based cohort. Dementia diagnoses were made using published criteria applied to an integration of videotaped portions of cognitive testing and neurological examination with more-detailed neuropsychological testing and informant measures. The researchers asked informants (293 spouses, 317 adult children) directly whether the subjects had received an evaluation for memory concerns; responses to these questions were used as the only surrogate marker for a previous clinical cognitive evaluation (CCE), regardless of subject self-report, medical record review, or available claims data.

Previous CCE of subjects was reported for approximately 1% of subjects with normal cognition, 5% with mild cognitive impairment, and 45% with dementia. Current marital status was the only significant, independent predictor of having undergone CCE (odds ratio, 2.63). Other notable trends included higher likelihood of CCE with increasing Clinical Dementia Rating score (CDR; a functional assessment tool for dementia) and lower likelihood of CCE in octogenarians than in septuagenarians.

Citation(s):

Kotagal V et al. Factors associated with cognitive evaluations in the United States. Neurology 2014 Nov 26; [e-pub ahead of print].