AAN Calls for Annual Cognitive Testing; USPSTF Begs to Differ

Megan Brooks

September 19, 2019

A new guideline released by the American Academy of Neurology (AAN) calls for annual cognitive testing in all adults age 65 years or older.

The AAN's position runs contrary to a draft recommendation by the US Preventive Services Task Force (USPSTF) released earlier this month.

As reported by Medscape Medical News, the USPSTF concluded that the "current evidence is insufficient to assess the balance of benefits and harms of screening for cognitive impairment in older adults."

However, the AAN believes otherwise.

"People often don't report memory and thinking problems on their own, or they may not recognize that they are having problems," AAN fellow Norman Foster, MD, of the University of Utah in Salt Lake City and lead author of the AAN guideline, told Medscape Medical News.

"Annual assessments will not only help identify mild cognitive impairment (MCI) early, it will also help physicians more closely monitor possible worsening of the condition," said Foster.

In light of these conflicting recommendations regarding annual cognitive screening, Medscape Medical News reached out to the USPSTF for comment, but was told task force members "can't comment directly on other organizations' recommendations."

However, when the USPSTF draft recommendation was initially released, task force member Seth Landefeld, MD, chairman, Department of Medicine, University of Alabama at Birmingham, told Medscape Medical News the task force "continues to encourage clinicians to remain alert for signs and symptoms of cognitive impairment and talk with patients and families about any concerns they have."  

The AAN's annual screening recommendation is part of a set of six quality measures developed by Foster and an expert working group that are intended to "drive quality improvement in practice."

The quality measures were published online yesterday in Neurology.

MCI Quality Measurement Set

1

Perform annual cognitive assessment for patients 65 and older

2

Perform cognitive and functional assessment for patients with MCI or memory loss

3

Disclose MCI diagnosis and provide counseling on treatment options

4

Assess and treat factors contributing to MCI

5

Avoid anticholinergic medications in patients with MCI

6

Educate care partners of patients with MCI

 

Worldwide, MCI affects nearly 7% of those in their early 60s and 38% of individuals age 85 and older. "MCI is clinically important, but often not recognized, and if recognized may not be addressed. Since cognition is the most sensitive indicator of brain function, and is cost-effectively assessed, this creates an enormous opportunity to improve neurologic care," the authors write.

"There is no mandate to use all 6 measures in the set, and clinicians are encouraged to start quality improvement efforts small. Potentially, clinicians may find using 1 or 2 of these quality measures beneficial to ensure care is consistently provided and address disparities in care given," they add.

Alzheimer's Association Support

The Alzheimer's Association applauds the AAN for adding annual cognitive assessments for people age 65 years or older to its list of quality measures.

"Annual cognitive assessments are a valuable tool to identify cognitive changes that can signal treatable forms of cognitive decline and more severe chronic conditions, including mild cognitive impairment, Alzheimer's disease or other dementias," Joanne Pike, DrPH, chief program officer, Alzheimer's Association, said in a statement.

"By adopting the new quality measure, physicians, clinicians, medical practices, and health systems can systematically measure whether providers are working to identify memory and thinking changes in their senior patients. Adopting these assessments is an important step toward improving patient outcomes, while also inviting important discussions about cognitive concerns, which seniors may not share otherwise," said Pike.

"Early detection of cognitive impairment," she added, "offers an opportunity to diagnose and potentially reverse treatable forms of cognitive decline. For more serious cognitive conditions such as Alzheimer's and other dementias, early detection and diagnosis enables access to symptomatic treatments, more time for critical care planning, better disease management, participation in clinical trials, and an opportunity for diagnosed individuals to have a voice in their future care."

"In addition, the quality measurement set includes the identification and involvement of care partners as informants, providing an opportunity to monitor their progress over time to ensure they receive care and support services," said Pike.

Neurology. Published online September 18, 2019. Full text

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