From the Guidelines
The Medicare wellness screening for cognitive impairment uses the Annual Wellness Visit (AWV) which includes a cognitive impairment screening, specifically the Mini-Cog test or the General Practitioner Assessment of Cognition (GPCOG) 1.
Key Features of Screening Tools
- The Mini-Cog test has a sensitivity of 76% and specificity of 89% for identifying people with possible dementia 1.
- The General Practitioner Assessment of Cognition (GPCOG) is widely used outside the United States in general practitioner settings and is more suited for detection of dementia than mild cognitive impairment (MCI) 1.
Considerations for Choosing a Screening Tool
- Clinicians should choose a test that is best suited to their practice setting, patient characteristics, and available time for testing 1.
- The Mini-Mental State Examination (MMSE) is the most widely known and best-studied brief test of cognition, but it has copyright restrictions on its use and alternative tools like the MoCA have comparable or better diagnostic accuracy for MCI and dementia 1.
- Other screening tools like the Memory Impairment Screen, Alzheimer Disease 8-Item Informant Interview, and short version of the Informant Questionnaire on Cognitive Decline in the Elderly can also be used in specific contexts 1.
From the Research
Screening Tools for Cognitive Impairment
- The PROMIS Cognitive Function Screener (PRO-CS) is a patient-reported outcome measure used to screen for cognitive impairment during the Medicare Annual Wellness Visit (AWV) 2.
- The PRO-CS has two versions: Abilities and Concerns, which have similar associations with patient clinical characteristics, but the Concerns version is more acceptable to patients 2.
Usage Patterns of Cognitive Assessments
- A national survey found that 31% of Medicare beneficiaries underwent formal cognitive testing during their AWV, while 35% were asked about memory problems 3.
- The use of structured cognitive assessments did not increase with higher AWV uptake, and individuals at higher risk of cognitive impairment were not more likely to be assessed 3.
Effects of Screening for Geriatric Conditions
- Screening for geriatric conditions, including cognitive impairment, during the AWV can lead to referrals and orders for further evaluation and treatment 4.
- Positive screening rates for cognitive impairment were 23%, and the adjusted odds of having an order placed in response to the screening were 1.4 4.
Recommendations for Operationalizing Cognitive Assessment
- The Alzheimer's Association recommends using a combination of methods, including review of patient Health Risk Assessment (HRA) information, patient observation, unstructured queries, and structured cognitive assessment tools, to detect cognitive impairment during the AWV 5.
Effect of the Medicare Annual Wellness Visit on Detection of Cognitive Impairment
- A cohort study found that the AWV was correlated with an increase in some measures of cognitive care, but it did not substantially increase recognition of undetected Alzheimer's disease and related dementia (ADRD) 6.