Last week, the Institute on Aging welcomed James E. Galvin, MD, MPH, Professor of Neurology, Psychiatry, and Nursing, New York University, to participate in the IOA Visiting Scholars Series. His presentation, titled “Detection of Cognitive Impairment in Multicultural Communities,” discussed different methods of diagnostic testing as well as the process and factors of these methods.
The risk of Alzheimer’s disease in African Americans and Hispanics is 1.5 – 2 times greater than in Caucasians, and the risk in women is 1.5 times greater than men. While most of Alzheimer’s and dementia cases are not caught until later in the disease, he explained that early detection of these conditions through clinical diagnoses is increasingly important, especially in order to enroll in research as soon as possible.
Patients or their family members are often the first to report any early signs or symptoms of cognitive impairment, most commonly after noticing a decline in memory. However, the process of a diagnosis does not end there. Clinical screenings such as the Mini Mental State Exam (MMSE), Mini-Cog, or Clinical Dementia Rating (CDR) can be administered, but some of these methods can be very time consuming and impractical for routine use. More formal neuropsychological testing can also be a very helpful tool, but depending on geographic location and the prevalence of specialists in your area, this option is not always readily available. For example, in New York, it is as if there is a psychologist on every corner, explained Dr. Galvin, however, in more Midwestern states such as Missouri, specialists are exceptionally more difficult to come by.
Dr. Galvin stressed the idea that regardless of what screening or evaluative method is used, one of the main factors to focus on during the detection of cognitive impairment is the onset of obvious change in a person’s mood or behavior. If an elderly person is experiencing symptoms related to dementia, it should only raise concern if these symptoms are recently developed, new occurrences.
Another common theme that seems to surround the issue of early diagnoses is the relatively low level of understanding, awareness, and familiarity with the detection of these conditions, both in the patient and the physician. Patients often recognize their symptoms, but not the severity of the problem, therefore they are not identifying with the condition. According to research, they are also typically very willing to undergo screening and evaluation, however, they are simply unaware that Primary Care Physicians are able to do so.
Dr. Galvin also revealed that generally speaking, physicians tend to “lack knowledge about dementia” and are much more likely to recognize a well developed disease compared to a new onset. More experienced physicians are also more likely to simply “screen” by asking a patient general questions such as “How is your memory?” whereas younger, less experienced physicians are more likely to provide a much more in-depth screening.
As previously mentioned, more formal screenings for dementia can be time consuming and very hard to come by, which can be quite an inconvenience toward the goal of early detection. In an effort to address this issue, Dr. Galvin and his colleagues developed the AD8 test (see image below), a “brief, valid, and reliable informant-based measure that is sensitive and predictive in discriminating nondemented older adults from those with even mild forms of dementia from all causes in an efficient, inexpensive, culturally sensitive and socially acceptable manner that is generalizable and translatable to the community-at-large.”
Taking only a few minutes to administer, this “yes/no” format questionnaire provides a significantly more convenient way to detect change in a patient compared to their previous levels of function and ultimately detect even mild levels of cognitive impairment. It is often paired with performance measurement tests such as Mini-PPT (Mini Physical Performance Test) and the use of measurement tools such as Dynamometer to test grip strength, Body Composition Scales to measure impedance, and tape measures to determine girth. Such tests are very helpful in detecting sarcopenia, the loss of muscle mass and strength as you age, which has been linked to a higher risk of cognitive impairment.
View Dr. Galvin’s full description of AD8 here: