From the Guidelines
Yes, dementia screening can be conducted in hospital wards. Initial screening can be performed using brief cognitive assessment tools such as the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), or the Mini-Cog, which typically take 5-10 minutes to administer 1. These tools assess various cognitive domains including orientation, memory, attention, language, and visuospatial abilities. When conducting ward-based screening, ensure a quiet environment with minimal distractions, choose an appropriate time when the patient is alert and not fatigued, and consider factors that might affect performance such as delirium, medication effects, or sensory impairments. It's essential to note that ward-based screening provides preliminary information only and is not diagnostic; abnormal results should prompt referral for comprehensive cognitive assessment by specialists. The benefit of ward-based screening is early detection of cognitive impairment, which can inform discharge planning, medication management, and follow-up care arrangements, potentially improving patient outcomes through timely intervention.
Some key considerations for ward-based screening include:
- Using a validated screening tool, such as the MMSE or MoCA, to assess cognitive function 1
- Ensuring the patient is alert and not fatigued, and minimizing distractions during the screening process 1
- Considering factors that may affect performance, such as delirium, medication effects, or sensory impairments 1
- Referring patients with abnormal results for comprehensive cognitive assessment by specialists 1
Overall, while the evidence on routine screening for dementia is insufficient, clinicians should remain alert to early signs or symptoms of cognitive impairment and evaluate as appropriate 1. Ward-based screening can provide valuable preliminary information and inform care planning, but it is essential to prioritize comprehensive assessment and diagnosis by specialists.
From the Research
Dementia Screening in Wards
- Dementia screening can be done in various settings, including primary care and general hospital inpatients 2, 3.
- Brief screening tools, such as the Abbreviated Mental Test Score (AMTS), can detect some persons with early dementia, with a sensitivity of 81% and specificity of 84% 3.
- Other screening tools, like the Mini-Cog, Memory Impairment Screen, and General Practitioner Assessment of Cognition (GPCOG), have shown promise for broad application in primary care settings 4.
- A web-based app combining cognitive tests and biomarkers can assist primary care professionals in screening dementia, with high usability scores 5.
Feasibility of Dementia Screening in Wards
- Screening for dementia in general hospital inpatients can be done using validated instruments, such as the AMTS 3.
- Understanding the strengths and weaknesses of currently available instruments allows informed decisions about screening in this setting 3.
- Web-based applications can be effective in addressing different needs, such as screening, health counseling, and improving overall health status 5.
Available Screening Tools
- Addenbrooke's Cognitive Examination (ACE) is considered an ideal tool for predicting the development of dementia, with a revised version (ACE-R) being used in clinical practice 6.
- The GPCOG and RUDAS cognitive tools are adequate for primary care settings and for screening multicultural and special needs populations, without educational or language bias 5.
- The CAIDE model can be used to assess biomarkers and provide individualized proposals concerning modifiable risk factors 5.