Tool May Help Detect, Monitor Multiple Symptoms of Aging

Megan Brooks

January 09, 2015

A new tool may provide a simple and reliable way to detect and monitor cognitive, functional, and psychological symptoms in aging adults, according to the tool's developers, who are from the Regenstrief Institute and Indiana University Center for Aging Research, in Indianapolis.

The Healthy Aging Brain Care (HABC) Monitor "helps busy physicians accurately measure and monitor the severity of symptoms, providing valuable information that the patient's entire care team needs," Malaz Boustani, MD, MPH, notes in a statement.

"We have been using this tool in the Eskenazi Health System for more than 2 years," Dr Boustani, medical director of the Eskenazi Health Healthy Aging Brain Center, in Indianapolis, told Medscape Medical News.

"We use it every time the patient comes to the clinic, just like you'd take a patient's blood pressure at every visit. I can compare it with the last visit, and I have a dashboard to track the numbers and decide if my care plan is working or if I should make modifications," he said.

Quick and Easy

The HABC Monitor includes 27 items on a 4-point scale to assess cognitive, functional, and psychological symptoms. There are self-report and caregiver versions, which can be completed online or with paper and pencil in 2 to 3 minutes. The tool asks caregivers and patients questions such as, during the past 2 weeks, how often have you (or your loved one) had problems with the following:

  • Repeating the same things over and over, such as questions or stories

  • Forgetting the correct month or year

  • Handling complicated financial affairs, such as balancing a checkbook, income taxes, and paying bills

  • Planning, preparing, or serving meals

  • Taking medications in the right dose at the right time

  • Walking or physical ambulation

  • Taking less interest or pleasure in doing things, hobbies, or activities

  • Feeling anxious, nervous, tense, fearful, or panic

  • Hearing voices, seeing things, or talking to people who are not there

  • Wandering, pacing, or doing things repeatedly

Dr Boustani and colleagues previously validated the caregiver report version of the HABC Monitor for measuring and monitoring symptoms (Monahan et al, Clin Interv Aging. 2012;7:143-157).

In an article published online December 5 in Clinical Interventions in Aging, they report a validation study of the patient self-report version of the tool.

Participants included 291 adults aged 65 years and older from Eskenazi Health primary care clinics; 56% were African-American, and 76% were women.

The researchers note that the self-report version of the HABC Monitor demonstrated "good reliability and validity as a clinically practical multidimensional tool for assessing and monitoring symptoms of older adults attending primary care clinics."

The self-report tool performed equally well as the caregiver report tool. However, if a patient self-reports a perfect cognitive score, the researchers note that further testing should be performed to rule out the possibility that the patient is denying or is unaware of their cognitive symptoms.

A lack of longitudinal data to estimate test-retest reliability of the self-report version during brief periods or to test sensitivity to change during longer periods is a limitation of the current study, the researchers note.

A future study should assess the sensitivity to change of the self-report version to that of "valid but lengthier" tools, such as the Neuropsychiatric Inventory, they suggest.

Beneficial Concept

Commenting for Medscape Medical News, Keith Fargo, PhD, director of scientific programs and outreach at the Alzheimer's Association, said, "This research is about early and accurate detection and cognitive assessment, and the Alzheimer's Association is supportive of ongoing research in that area. This concept of ongoing assessment and evaluation of a person's cognitive state is a beneficial concept, and there is a need for this kind of tool [to be] used under the supervision of a healthcare professional."

Dr Fargo noted that the Alzheimer's Association "for several years now has been making efforts toward having cognitive assessment included, for example, in the Medicare annual wellness visit, because we do think it's important for physicians to have a baseline on all of their patients and then be able to track that over time to see whether there is a deviation from that baseline so they can intervene as early as possible."

The study was funded by the National Institute of Mental Health and the National Institute on Aging. The HABC Monitor is copyrighted by Dr Boustani, two colleagues, and the Indiana University School of Medicine. The authors have disclosed no relevant financial relationships.

Clin Interv Aging. 2014;9:2123-2132. Full text

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