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New brief tool to screen for cognitive impairment in elderly patients

Dementia and cognitive impairment are widespread among elderly individuals in the United States, affecting more than 8 million people to some degree.

The Sweet 16, a new screening test developed by a team of geriatricians and neurologists at the Institute for Aging Research of Hebrew SeniorLife and Beth Israel Deaconess Medical Center, could help clinicians more rapidly detect dementia in elderly patients.

The Sweet 16 will be available without charge to any nonprofit organization, and may provide an alternative to the Mini-Mental State Examination. The findings are described in the Nov. 8, 2010 online issue of the Archives of Internal Medicine.

"A recent study showed that more than 30 percent of hospitalized patients over age 75 had some degree of cognitive impairment," says lead author Tamara Fong, M.D., Ph.D., an assistant scientist at the Institute for Aging Research. "While the public health impact of cognitive impairment, including loss of independence, decreased quality of life, and increased health-care costs, is clear, this condition is often underrecognized in health-care settings."

Routine measurements of cognitive function can help clinicians detect dementia at earlier stages, which, in turn, helps them better assess the severity of the disease, as well as to identify individuals at risk of developing delirium or functional impairments that could impair driving or otherwise pose a safety risk.

The Sweet 16 screening test consists of 16 measurements, designed to be implemented in a time frame of two to three minutes. Unlike previous assessment methods, the Sweet 16 does not rely on any props and does not require pencil or paper, which makes it more useful in or at the hospital bedside. Furthermore, notes Dr. Fong, unlike other cognitive screening tests, the Sweet 16 has been specially designed to accurately characterize mental status without influence by a patient's education or other sociodemographic factors.

Using data from the Aging, Demographics and Memory Study, a substudy of the Health and Retirement Study, a nationally representative panel survey of more than 20,000 people across the U.S. designed to examine the risks and outcomes of dementia and cognitive impairment, the authors examined how well the Sweet 16 performed in this population compared with another cognitive measure, the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), and clinicians' diagnoses for dementia.

"The Sweet 16 could be used in home, outpatient, hospital or long-term care settings," says Dr. Fong, who is also a neurologist at Beth Israel Deaconess Medical Center. "For frail, older or medically ill hospitalized or institutionalized patients, this type of streamlined assessment could be of particular benefit in evaluating risk of delirium or future cognitive decline and in assuring patient safety and decision-making capacity."

Study authors include Sharon K. Inouye, M.D., M.P.H. (senior author), Richard Jones, Sc.D., James Rudolph, M.D., S.M., Frances Yang, Ph.D., Douglas Tommet, M.S., Daniel Habtermariam, B.A., Edward Marcantonio, M.D., S.M., and Kenneth Langa, M.D., Ph.D.

Beth Israel Deaconess Medical Center is a patient care, teaching and research affiliate of Harvard Medical School and consistently ranks in the top four in National Institutes of Health funding among independent hospitals nationwide.

Scientists at the Institute for Aging Research seek to transform the human experience of aging by conducting research that will ensure a life of health, dignity and productivity into advanced age. The Institute carries out rigorous studies that discover the mechanisms of age-related disease and disability; lead to the prevention, treatment and cure of disease; advanced the standard of care for older people; and inform public decision-making.

Founded in 1903, Hebrew SeniorLife, an affiliate of Harvard Medical School, is a nonprofit organization devoted to innovative research, health care, education and housing that improves the lives of seniors.

Scott Edwards | EurekAlert!
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