Affiliations: [a] Geriatric Research Unit, Brain Sciences Program, Sunnybrook Health Sciences Centre; Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada | [b] Geriatric Research Unit, Brain Sciences Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada | Center for Alzheimer's Research, Banner Sun Health Research Institute, Sun City, AZ, USA
Correspondence:
[*]
Correspondence to: Mary C. Tierney, Ph.D., C. Psych, Geriatric Research Unit, A145 Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, Canada, M4N 3M5. Tel.: +1 416 480 4291; Fax: +1 416 480 6776; E-mail: mary.tierney@sunnybrook.ca.
Abstract: The incidence and prevalence in those over age 65 of neurodegenerative disorders and chronic diseases, which often have deleterious effects on cognition, are rapidly increasing in western societies. Primary care physicians (PCPs) provide the majority of medical treatment for older people and in order to effectively care for their patients with suspected cognitive impairment, they must have tools that will allow them to accurately assess their patient's cognitive function. This knowledge will assist the PCPs in formulating a diagnosis of dementia or cognitive impairment and provide an indication of risk of progression to dementia. It will also assist with monitoring response to treatment and care decisions, including medication management, capacity judgments, and the need for family involvement. Tests currently used in primary care, such as the Mini-Mental State Examination, do not accurately assess patients with mild cognitive impairments, and other tests more suitable for this purpose require further validation and may be too time-consuming in the primary care setting. A possible solution is the use of patient-administered computerized cognitive testing in the PCP's office. This systematic review identified eleven test batteries and three were judged potentially appropriate for cognitive assessment in the PCP's office. These three varied in their presentation format and the quality of cross-sectional validation studies, and none had longitudinal data for dementia prediction. Thus the existing test batteries show potential for use in primary care but further study is needed to demonstrate their feasibility and effectiveness in this setting.
Keywords: Cognition, computers, mild cognitive impairment, neuropsychological tests, primary care
