New Screening Tool To Detect Cognitive Problems in Elderly

Researchers at Cleveland Clinic have created a self-administered screening instrument that is highly effective and efficient for evaluating cognitive problems in elderly people.

Detecting mild cognitive impairment, early Alzheimer’s disease, and other related dementias can be done in a primary care setting using a quick test performed on a tablet computer before an annual physical, according to a recent study. The Journal of Alzheimer’s Disease reported the findings.

Mild cognitive impairment, a key risk factor for Alzheimer’s disease, affects 15% to 20% of Americans. When diagnosed, usually later in the course of the disease, a significant majority of individuals with mild cognitive impairment and early Alzheimer’s disease go undiagnosed and unreported.

“The goal of this low-cost screening is to incorporate testing into an annual physical for older adults and make it as routine as checking your blood pressure and weight,” said Stephen Rao, Ph.D., lead author of the study and director of the Schey Center for Cognitive Neuroimaging at Cleveland Clinic. “As the population ages and the incidence of Alzheimer’s and other dementias increases rapidly, it is critical that we find new ways to identify the disease early.”

For healthy older persons, there are currently no reliable screening tests for moderate cognitive impairment and early Alzheimer’s. Current diagnostic procedures like MRI, genetic testing, and PET scans are either inconclusive or too expensive to be offered to every patient. The 10-minute self-administered brain health evaluation was created by Dr. Rao and colleagues at Cleveland Clinic.

At Medicare annual wellness visits, the Cleveland Clinic Cognitive Battery (C3B) evaluates memory and cognitive abilities to effectively screen for cognitive impairment in persons 65 and older.

Through a series of trials, the research team validated the instrument. The first study involved an initial evaluation of 428 persons, aged 18 to 89, who were cognitively healthy and provided norms to help with clinical interpretation.

The technology was then integrated into a primary care clinic, where patients completed the computerized test while waiting to see their doctor. More than 95% of elderly patients over the age of 65 were able to complete the computerized exams without supervision, and a poll revealed that they were quite satisfied with the screening tool.

The tool was then evaluated in a group of 30 older persons with and without mild cognitive impairment, 30 of whom had the diagnosis. As compared to a standard screening tool already used in primary care clinical practice, the tool correctly detected 90% of patients with mild cognitive impairment.

“We demonstrated that the C3B tool was able to distinguish mild cognitive impairment patients from demographically matched people who did not have the condition,” said Dr. Rao. “Overall this study showed that this simple screening can be effectively used in a busy primary care setting for detecting mild cognitive impairment.”

Studying people before they have any symptoms of dementia is important because the disease can begin in the brain 10 to 20 years before diagnosis. If the disease can be detected earlier before significant brain damage occurs, patients can potentially modify their risk.

“Many risk factors such as physical inactivity, depression, obesity, and smoking are amenable for primary care intervention that could delay or prevent dementia if detected in the earliest stage of the disease,” said Dr. Rao.

“If we can slow down the disease to delay onset by five years we can cut the number of people diagnosed by half. If we can delay by 10 years, we can practically eliminate the disease and improve length and quality of life. Disease-modifying drugs and lifestyle interventions, like physical activity, can delay the diagnosis of dementia if implemented at the earliest stage of the disease.”

In order to increase the diversity of the test population and better define test result thresholds for cognitive dysfunction, Dr. Rao’s team is now preparing for a sizable multisite study. Participants will be chosen at random to have MRI scanning, laboratory tests, and a thorough neurological examination. These patients will include both patients who perform well and those who perform poorly on the C3B.

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