Detecting Dementia: Earlier Diagnosis and Better Outcomes

Editor’s Note: This post is written by Erica Zak, a second year medical student at the St. Louis University Medical School and an independent researcher at the EPX Research Center @WUSTL. Erica is part of the neuroscience group at the EPX Research Center and focuses on testing the Epharmix interventions’ application on behavioral health issues.

Overview

Dementia is a slowly progressive, yet debilitating disease that affects 47.5 million people worldwide [1]. This disease is characterized by a loss of cognitive functions, such as memory, comprehension, visual-spatial orientation and judgment. The most common form of dementia is Alzheimer’s disease, but vascular dementia and Lewy-body dementia can also cause cognitive impairment. There is currently no cure, but early intervention has been shown to increase the quality of life. It allows for patients to be more involved in their care plan and early pharmaceutical intervention could slow the progression of the disease and lead to better symptom management [2]. In addition, early diagnosis is associated with later admission into nursing facilities, which increases the quality of life and decreases the cost of care [3]. 

Current Standard of Care

Without a screening tool, physicians are able to identify 59% of patients with dementia and only 41% of patients with mild cognitive impairment [4]. Screening tools, like the Mini-Mental State Exam, detect dementia and cognitive impairment at much higher rates. This tool is administered in the physician’s office and can take 7 to 10 minutes to complete [5]. Due to this, time constraints may cause the physician to forgo a cognitive screen when the patient has a visit to address other symptoms. However, the Rapid Cognitive Screen is a 3 item screening tool that takes half the time to complete. This screen has exhibited good sensitivity and specificity in detecting both mild cognitive impairment and dementia in patients over the age of 65 [6].

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Cognitive Screening at Home

The Rapid Cognitive Screen is a useful tool to screen for patients in clinic, but telemedicine would allow for family members and caregivers to screen patients at home. Epharmix is developing a text based system to allow for the administration of this screen in between physician visits. A designated caregiver would receive instructions via text every six months. The caregiver would administer the screen and input patient responses through text messages. The physician would receive the data and an alert if the patient’s scores indicated cognitive decline or dementia. Since most patients are only screened once a year at the physician’s office, this would allow for earlier detection in between visits, which is essential to providing care that not only improves quality of life but is also cost effective.

References

1). Van der Linde RM, Dening T, Blossom CM, et al. “Longitudinal course of behavioural and psychological symptoms of dementia: systematic review” The British Journal of Psychiatry. 2016 Aug; DOI: 10.1192/bjp.bp.114.148403

2). Dubois B, Padovani A, Scheltens P, Rossi A, Dell’Agnello G. “Timely diagnosis for Alzheimer’s disease: a literature review on benefits and challenges” Journal of Alzheimers Disease. 2015;49(3):617-31.

3). Weimer DL, Sager MA (2009) “Early identification and treatment of Alzheimer’s disease: Social and fiscal outcomes” Alzheimers Dement 2009; 5: 215 226

4). Borson S, Scanlan JM, Watanabe J, Tu S-P, Lessig M. Improving identification of cognitive impairment in primary care. Int J Geriatr Psychiatry 2006;21:349–55.

5). Ebell MH. “Brief screening instruments for dementia in primary care” American Family Physician. 2009 Mar; 15:79(6):497-500.

6). Malmstrom T, et al. “Rapid Cognitive Screen: Sensitivity and specificity for cognitive dysfunction and predictive validity for poor health outcomes” Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association , Volume 9 , Issue 4 , P773