From the Guidelines
The Medicare wellness screening for cognitive impairment in 2024 uses the Mini-Cog as a primary screening tool, which is a 3-minute test that includes a 3-item recall and a clock drawing test 1.
Key Features of the Mini-Cog
- The test consists of a 3-item registration, a clock draw, and recall 1
- The patient receives 1 point for each word recalled correctly and a dichotomous score (0 or 2) for the clock draw 1
- A score of less than 3 is concerning for possible dementia 1
Alternative Screening Tools
- The General Practitioner Assessment of Cognition (GPCOG) is another tool that may be used, which is a 4-item test that assesses cognitive function 1
- The Memory Impairment Screen is an alternative, verbally administered validated screening tool for people with motor disabilities that render them unable to perform the clock draw 1
- The AD8 (Eight-Item Informant Interview to Differentiate Aging and Dementia) is an informant-based questionnaire that can be provided to family members or support partners if the patient does not wish to participate in the mental status test 1
Further Evaluation
- If abnormal results are found, further evaluation with a comprehensive neurocognitive assessment, such as the Montreal Cognitive Assessment (MoCA), may be recommended 1
- The MoCA is a widely available test that assesses multiple cognitive domains, including memory, language, and visuospatial skills 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.
Instruments for Detection and Screening
- Numerous brief cognitive screens have been developed for primary care, including the MoCA, which can be used to incorporate brief cognitive screens into the AWV 4.
- Early recognition of cognitive problems allows clinicians and patients to discuss concerns, address possible reversible causes, or refer for further evaluation 4.
Effect of the Medicare Annual Wellness Visit
- A cohort study found that the AWV is correlated with an increase in some measures of cognitive care, such as laboratory testing for reversible causes of cognitive impairment, but it does not appear to substantially increase recognition of undetected Alzheimer's disease and related dementia (ADRD) 5.
- The AWV may have a positive effect on screening for geriatric conditions, including cognitive impairment, and can facilitate conversations about cognition between providers and patients 2, 6.