Why is it important to assess cognitive impairment in older adults?

Cognitive impairment in older adults has a variety of possible causes, including medication side effects, metabolic and/or endocrine derangements, delirium due to inter-current illness, depression, and dementia, with Alzheimer’s dementia being most common. Some causes, like medication side effects and depression, can be reversed with treatment. Others, such as Alzheimer’s disease, cannot be reversed, but symptoms can be treated for a period of time and families can be prepared for predictable changes.

When is screening indicated?

The U.S. Preventive Services Task Force, in its recent review and recommendation regarding routine screening for cognitive impairment, noted that “although the overall evidence on routine screening is insufficient, clinicians should remain alert to early signs or symptoms of cognitive impairment (for example, problems with memory or language) and evaluate as appropriate.”11 The Dementia Screening Indicator (http://bit.ly/1pxk5rI) can help guide clinician decisions about when it may be appropriate to screen for cognitive impairment in the primary care setting.12

Benefits of early screening

1. If screening is negative: Patient/family concerns may be alleviated, at least at that point in time.
2. If screening is positive and further evaluation is warranted: The patient/family and physician can take the next step of identifying the cause of impairment (for example, medication side effects, metabolic and/or endocrine imbalance, delirium, depression, Alzheimer’s disease).
   This may result in:
3. Treating the underlying disease or health condition.
4. Managing comorbid conditions more effectively.
5. Averting or addressing potential safety issues.
6. Allowing the patient to create or update advance directives and plan long-term care.
7. Ensuring the patient has a caregiver or someone to help with medical, legal, and financial concerns.
8. Ensuring the caregiver receives appropriate information and referrals.
9. Encouraging participation in clinical research.

For more information on your Dual Special Needs members

For your patients enrolled in the Horizon NJ TotalCare Program HMO SNP, each member is assigned a DSNP Care Manager who will assess for physical and behavioral health needs as well as perform a Brief Interview for Mental Status (BIMS) Assessment. Any findings of note will be incorporated into the members care plan and coordinated with the primary care provider. Additional resources for you the provider, as well as care givers can be found at:

A cognitive impairment (also known as an intellectual disability) is a term used when a person has certain limitations in mental functioning and in skills such as communication, self-help, and social skills. The following resources have been identified as providing useful information and resources to care givers and providers.

http://www.michiganallianceforfamilies.org/disability-specific-info/cognitive-impairment/

http://memory.ucsf.edu/education/diseases/mci

http://www.alz.org/dementia/mild-cognitive-impairment-mci.asp

http://www.parentcenterhub.org/repository/intellectual/