New Cognitive Impairment Recommendations from American Academy of Neurology

SEPTEMBER 18, 2019
Patrick Campbell
Doctor and older patientIn an effort to improve mental health across the nation, the American Academy of Neurology (AAN) is now recommending that patients 65 and older should undergo annual assessment for thinking and memory problems.

The new recommendation is part of a set of quality measurements published by the AAN, seeking to emphasize the impact of documenting mild cognitive impairment and early intervention in older patients.

“The American Academy of Neurology is recommending the measurement of annual cognitive screenings for everyone age 65 and older because age itself is a significant risk factor for cognitive decline and mild cognitive impairment is increasingly prevalent with older age,” said author Norman Foster, MD, of the University of Utah in Salt Lake City and a fellow of the AAN. “The measure complements past American Academy of Neurology quality measures released for Parkinson’s disease, multiple sclerosis and stroke, and allows for a doctor to meet the measure with a recommended periodic three-minute cognitive test.” 

The new measurement set, which are based on existing AAN guideline recommendations from 2018, contains 6 quality measurements aimed at improving care and patient outcomes. Published on September 18, the measurements are derived from systematic review of more than 1900 articles  which were published between 2013 to late 2017 — a group of 227 articles were considered to be of interest to the investigators. 



From the literature included in the final analysis, investigators identified 27 possible measurements that were subsequently ranked and evaluated. Measures were ranked by meaningfulness, feasibility to collect, and support from available evidence.

Of the 27, 8 were excluded from further development, 6 were bundled into 1 concept, and 3 related concepts were bundled into a single concept. Further criteria led to the elimination of 4 other concepts following reviews of counseling regarding supplements, acetylcholinesterase inhibitors or memantine counseling, and care planning visits.
 
Investigators approved 6 measures they believed reflected an opportunity to improve the care of patients with mild cognitive impairment and represent practical steps to overcoming gaps in detection, evaluation, and treatment. 


The 6 new measures recommended by the AAN include annual cognitive health assessments for patients 65 years and older, cognitive and functional assessments for patients with mild cognitive impairment or memory loss, diagnosis disclosure and counseling on treatment options for patients, assessment and treatment of factors contributing to mild cognitive impairment, avoidance of anticholinergic medications for patients, and providing education to care partners of patients.

“We cannot expect people to report their own memory and thinking problems because they may not recognize that they are having problems or they may not share them with their doctors,” said Foster. “Annual assessments will not only help identify mild cognitive impairment early, it will also help physicians more closely monitor possible worsening of the condition.”

This review, titled “Quality improvement in neurology,” is published in Neurology.

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