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New Screening Tool for Dementia

Checklist Gauges Ability of Older Adults to Perform Everyday Tasks
By
WebMD Health News
Reviewed by Louise Chang, MD

July 2, 2008 -- Grandma seldom forgets where she puts her keys. Check.

She can still whip up her favorite dish while regaling you about Uncle Joe's latest escapades. Check.

She always knows where her car is parked, and might even point out where yours is, too. Check.

Answering basic questions that track an older adult's ability to perform everyday tasks may help doctors detect the early warning signs of dementia. However, until now methods to assess everyday function have been limited.

Now researchers have developed a quick and easy screening tool called Everyday Cognition (ECog), which can reveal changes in older adults' basic mental abilities over time when filled out by someone who is close to them. For example, an adult child may answer questions about a parent or spouses may answer questions about each other.

Sarah Tomaszewski Farias, PhD, of the University of California, Davis, and colleagues came up with a new questionnaire after evaluating data on 576 adults about 77 years old and interviewing health care professionals who worked with people with dementia. The idea for ECog stemmed in part from a concept that suggests one could measure different areas of everyday function by matching specific tasks to particular cognitive abilities.

The team identified seven key cognitive areas: memory, language, factual knowledge (semantics), visuo-spatial abilities, planning, organization, and divided attention, and eventually came up with 39 questions.

How the Checklist Works

The checklist asks reliable informants -- people who lived with or know the older adult well -- to compare an adult's current ability to perform specific tasks to 10 years ago. Is the older adult's ability better, questionable, a little worse, or much worse?

For example:

"Compared to 10 years ago, has there been any change in ..."

  • Remembering where she/he has placed objects
  • Forgetting the names of objects
  • Remembering the meaning of common words
  • Following a map to find a new location
  • Finding his/her way around a familiar neighborhood
  • Planning the sequence of stops on a shopping trip
  • Keeping living and work space organized
  • Keeping financial records organized
  • Cooking or working and talking at the same time

The researchers had reliable informants validate their new screening tool. On average, each person filling out the questionnaire knew the older adult for about 45 years and spent an average of 75 hours a week with the person. Informants included spouses, adult children, family members, or friends. Most were women.

Informants can offer a more candid picture of a person's functional ability than clinicians or patients themselves. A person with dementia can lose awareness of their problems, and health care workers aren't often around on a daily basis to evaluate the intricacies of say, making a peanut-butter-and-jelly sandwich.

The study showed that the new screening questionnaire was "a promising instrument for the measurement of daily function in older adults," the researchers conclude in the journal article. ECog appeared sensitive to early functional changes and allowed Farias' team to distinguish between adults with normal cognition, mild cognitive impairment, and dementia.

"The ECog shows great promise as a useful screening measure for detecting individuals at increased risk for developing dementia. What's more, its results do not appear to be strongly influenced by the role of education, as is the case in other cognitive tests," the researchers says in a news release.

The new ECog screening test could be extremely useful in the offices of primary care doctors, where symptoms of dementia often go undiagnosed, according to background information in the journal article.

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