Cognitive Screening

It has been estimated that as many as 1.8 million cases of dementia in the United States that are currently unrecognized and/or not receiving medical and social services.¹ Despite the efforts of organizations such as the Alzheimer's Association, the signs and symptoms of cognitive impairment are often unrecognized by family members, friends, and clinicians. Many factors may contribute to the under recognition of AD and other dementias including expectations that cognitive impairment is a part of normal aging, lack of insight in the impaired individual, the individual's fear of diagnosis, unavailability of trained clinicians or specialty care, and reluctance of family members and friends to discuss the issue of memory loss with the individual. In addition, due to the gradually progressive nature of the disorder and often subtle initial symptoms; even trained professionals may find early diagnosis difficult.

Routine cognitive screening has been proposed as a procedure to increase early diagnosis of AD and other types of cognitive impairment.²The Agency of Health Care Policy and Research (AHCPR) expert consensus panel on recognition of Alzheimer's disease concluded in 1996 that none of the available assessment instruments met their criteria for a widely applicable screening instrument.³

The importance of early and accurate diagnosis of AD and other dementias cannot be overemphasized. Early assessment and diagnosis provides benefits to both patients and their caregivers. Patients with vascular dementia may prevent further progression by aggressively controlling risk factors such as hypertension. In the case of cholinesterase inhibitor therapy for AD, a more robust response and the potential for extending the period of optimal functioning may be achieved by starting treatment early in the course of the illness. Other advantages of early diagnosis of AD are listed in the table below.

adapted from reference ²