• Courtney Hess, Boaz Levy, Ardeshir Z Hashmi, Jacqueline Hogan, Sarah Greenspan, Allison Elber, Kathryn Falcon, and Daniel F Driscoll.
• From the Department of Counseling and School Psychology, University of Massachusetts, Boston, MA (CH, BL, JH, SG, AE, KF); Cleveland Clinic, Lerner College of Medicine, Ohio (AH); Tufts University School of Medicine, Boston, MA (DD); and McLean Hospital, Belmont, MA, Harvard Medical School (BL).
• J Am Board Fam Med. 2020 May 1; 33 (3): 417-425.

PurposeThis study examined the clinical utility of highly efficient subjective and objective screens of cognitive impairment.MethodParticipants (N = 124, age ≥ 65, mean = 73.59, SD = 6.26) completed a 2-item questionnaire of subjective memory functioning, a brief computerized cognitive test, and the Montreal Cognitive Assessment (MoCA). Next, participants were assigned to 1 of 4 conditions, based on their subjective (low/high) and objective (impaired/unimpaired) levels of cognitive functioning. Further analysis divided the sample into age-based groups (ie, age < 75, age ≥ 75).ResultsThe proportion of participants in the impaired subsample (ie, MoCA < 26), who reported a high level of subjective concern about their memory, was low (ie, 0.15). Among unimpaired participants, analysis detected significant group differences across subjective memory levels (P < .0003) and age (P < .005) categories on one of the three tasks of the computerized test (ie, cognitive control). In contrast, the MoCA offered no differentiation between these groups.ConclusionScreening protocols in which cognitive testing is administered subsequent to patient complaint are prone to underdiagnosis. In addition, common dementia screens are insensitive to subjective deficits and healthy cognitive aging. Therefore, they may lead to dismissing valid concerns that deserve preventive attention. Primary care needs efficient screening tools that are sensitive to prodromal decline.© Copyright 2020 by the American Board of Family Medicine.

13 keywords...

hide…