Expert Provincial Task Group Recommends Alternative Tools for Use in Screening for Cognitive Impairment

FOR IMMEDIATE RELEASE

July 29, 2020

A Provincial Expert Task group, convened to review options for cognitive screening tests, has reported that there are several well validated tools that are freely available for use in primary care.

In response to developments related to the availability of previously free access cognitive screening tools (e.g. the Montreal Cognitive Assessment or MoCA(c)), the Provincial Geriatric Leadership Office (PGLO) and RGPs of Ontario (RGPO) issued a statement in Fall 2019, discouraging the commitment of financial resources by clinicians and health care organizations to procure training or certification in the use of cognitive screening tools from any specific vendor, until such time as a review of cognitive screening tools was complete.  The PGLO and RGPs of Ontario immediately convened the Provincial Expert Task Group to lead a review of clinical screening tools to provide the needed advice to the clinical field about evidence-based options. The intent was to inform clinical decision making and choice about available, high quality cognitive screening tools for use in clinical practice. This review is now complete.

The article “One Size Does Not Fit All: Choosing Practical Cognitive Screening Tools for Your Practice“, written by Dr. Frank Molnar, Dr. Sophiya Benjamin, Stacey Hawkins, Melanie Briscoe and Dr. Sabeen Ehsan, all members of the PGLO/RGPO Expert Task Group, has been published by the Journal of the American Geriatric Society 1. The Task Group built upon a U.S. Preventive Services Task Force (USPSTF) systematic review 2, 3 that identified 16 screening tools previously validated in at least two primary care settings. To this list, the Task Group applied seven filters, called PRACTICAL.1 criteria1, that can help the clinician determine a screening test that might be appropriate for their setting and patient. The Task Group rated these tools on ease of access, training requirements, and clear scoring recommendations among other criteria. The authors note that while many clinicians have reached out with the question of which is the best screening test, the results of this review suggests that there are several useful screening tests and empowers the clinician to make decisions based on patient centred factors”.

The key messages from the authors of this work are:

  • A screening test is not the same as a comprehensive assessment. Clinicians in specialized geriatric service setting are expected to use clinical acumen in conjunction with standardized, valid, reliable instruments as appropriate4.
  • For busy clinicians in primary care who are screening for cognitive impairment, there are a variety of tests that are currently free of cost, have clear training and scoring information with established validity in a primary care setting. Four tools met all of the PRACTICAL.1 criteria and take less than 5 minutes to administer. There are other good tools that take less than 10 minutes but more than 5 minutes. The article outlines the PRACTICAL.1 criteria and provides links to each of the screening tools.
  • A positive screen does not mean the individual has dementia. Rather, it alerts the clinician to obtain a more thorough history and perform a clinical exam and investigations as needed to rule in or rule out the diagnosis of a neurocognitive impairment and determine the type and or cause of dementia.
  • Given that as of September 2020, access to obtain the MoCA(c) test will be restricted to users who pay for certification, the authors have recommended building a website to house the tools and resources that are valid and that will continue to be available free of charge. This work is underway using the results from this publication.  In the interim, clinicians may wish to begin using the identified tools, which are available through the links provided within the article. https://onlinelibrary.wiley.com/doi/full/10.1111/jgs.16713

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Discussion or questions are invited and can be directed to info@rgpo.ca

References:

  1. Molnar, F.J., Benjamin, S., Hawkins, S.A., Briscoe, M. and Ehsan, S. (2020), One size does not fit all: Choosing practical cognitive screening tools for your practice. J Am Geriatr Soc. doi:10.1111/jgs.16713
  2. The US Preventive Services Task Force (USPSTF) members, DK O, Davidson KW, Krist AH, et al. Screening for cognitive impairment in older adults: US Preventive Services Task Force recommendation statement. JAMA. 2020; 323(8): 757‐ 763. https://doi.org/10.1001/jama.2020.0435 https://jamanetwork.com/journals/jama/fullarticle/2761651.
  3. Patnode CD, Perdue LA, Rossom RC, et al. Screening for cognitive impairment in older adults: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2020; 323(8): 764‐ 785. https://doi.org/10.1001/jama.2019.22258 https://jamanetwork.com/journals/jama/fullarticle/2761650.
  4. Kay, K., Hawkins, S., Day, A., Briscoe, M., Daly, D., and Wong, K. (2017). A competency framework for interprofessional comprehensive geriatric assessment. Regional Geriatric Programs of Ontario. https://rgps.on.ca/wp-content/uploads/2019/03/A-Competency-Framework.pdf