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From the Department of Neurology (Dr. Petersen), Mayo Clinic, Rochester, MN; Lutheran Medical Office (Dr. Stevens), Fort Wayne, IN; Department of Psychiatry, University of Pittsburgh School of Medicine and Department of Epidemiology, University of Pittsburgh Graduate School of Public Health (Dr. Ganguli), Pittsburgh, PA; Department of Internal Medicine (Dr. Tangalos), Mayo Clinic, Rochester, MN; Departments of Neurology and Psychiatry & Biobehavioral Science (Dr. Cummings), University of California at Los Angeles; Departments of Neurology and Psychiatry (Dr. DeKosky), University of Pittsburgh, PA.
Address correspondence and reprint requests to the Quality Standards Subcommittee, American Academy of Neurology, 1080 Montreal Ave., St. Paul, MN 55116.
OBJECTIVE: The goal of this project was to determine whether screening different groups of elderly individuals in a general or specialty practice would be beneficial in detecting dementia.
BACKGROUND: Epidemiologic studies of aging and dementia have demonstrated that the use of research criteria for the classification of dementia has yielded three groups of subjects: those who are demented, those who are not demented, and a third group of individuals who cannot be classified as normal or demented but who are cognitively (usually memory) impaired.
METHODS: The authors conducted computerized literature searches and generated a set of abstracts based on text and index words selected to reflect the key issues to be addressed. Articles were abstracted to determine whether there were sufficient data to recommend the screening of asymptomatic individuals. Other research studies were evaluated to determine whether there was value in identifying individuals who were memory-impaired beyond what one would expect for age but who were not demented. Finally, screening instruments and evaluation techniques for the identification of cognitive impairment were reviewed.
RESULTS: There were insufficient data to make any recommendations regarding cognitive screening of asymptomatic individuals. Persons with memory impairment who were not demented were characterized in the literature as having mild cognitive impairment. These subjects were at increased risk for developing dementia or AD when compared with similarly aged individuals in the general population.
RECOMMENDATIONS: There were sufficient data to recommend the evaluation and clinical monitoring of persons with mild cognitive impairment due to their increased risk for developing dementia (Guideline). Screening instruments, e.g., Mini-Mental State Examination, were found to be useful to the clinician for assessing the degree of cognitive impairment (Guideline), as were neuropsychologic batteries (Guideline), brief focused cognitive instruments (Option), and certain structured informant interviews (Option). Increasing attention is being paid to persons with mild cognitive impairment for whom treatment options are being evaluated that may alter the rate of progression to dementia.
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