Office- and Bedside-based Screening for Cognitive Impairment and the Dementias: Which Tools to Use, Interpreting the Results, and What Are the Next Steps?

Elderly patients and their families are concerned about the patients' cognitive abilities, and cognitive screening is an efficient diagnostic tool, as long as clinicians administer the screens in a standardized manner and interpret the screen results accurately. The following brief summary reviews commonly used screening instruments and provides information about how to interpret screening test results. It concludes by showing how cognitive screening fits into a four-step process (Education, Screening, Follow-up, and Referral) of how to respond to patients with cognitive concerns.

A Primary Care Agenda for Brain Health: A Scientific Statement From the American Heart Association.

A healthy brain is critical for living a longer and fuller life. The projected aging of the population, however, raises new challenges in maintaining quality of life. As we age, there is increasing compromise of neuronal activity that affects functions such as cognition, also making the brain vulnerable to disease. Once pathology-induced decline begins, few therapeutic options are available. Prevention is therefore paramount, and primary care can play a critical role. The purpose of this American Heart Association scientific statement is to provide an up-to-date summary for primary care providers in the assessment and modification of risk factors at the individual level that maintain brain health and prevent cognitive impairment. Building on the 2017 American Heart Association/American Stroke Association presidential advisory on defining brain health that included "Life's Simple 7," we describe here modifiable risk factors for cognitive decline, including depression, hypertension, physical inactivity, diabetes, obesity, hyperlipidemia, poor diet, smoking, social isolation, excessive alcohol use, sleep disorders, and hearing loss. These risk factors include behaviors, conditions, and lifestyles that can emerge before adulthood and can be routinely identified and managed by primary care clinicians.

Vascular cognitive impairment.

Vascular cognitive impairment encompasses a spectrum of clinically defined syndromes ranging from vascular cognitive impairment-no dementia, to vascular dementia. The underlying cerebrovascular pathology includes both overt infarction as well as rarefaction of gray and white matter. Alzheimer's pathology may coexist with vascular pathology. Diagnosis rests on identifying acquired cognitive impairment in the setting of documented cerebrovascular disease, based on clinical presentation and neuroimaging; MRI is more sensitive than CT. The course can be stepwise or gradually progressive. The clinical picture is typically dominated by deficits in executive function rather than the short-term memory deficit typical of Alzheimer's disease. No specific therapies exist, but treatment with anticholinesterase agents and N-methyl-d-aspartate antagonists may result in clinical improvement. Prevention remains paramount, with early recognition of populations at risk and early and aggressive management of risk factors, including hypertension, dyslipidemia, diabetes, and tobacco use as well as antithrombotic therapy, in appropriate populations.

The pattern of neuropsychological deficits in Vascular Cognitive Impairment-No Dementia (Vascular CIND).

We examined the pattern of neuropsychological deficits in Vascular Cognitive Impairment-No Dementia (Vascular CIND) by comparing the cognitive and behavioral performance of 41 post-stroke Vascular CIND patients to that of 62 post-stroke patients with no cognitive impairment (NCI). Neuropsychological test scores were grouped into seven cognitive and four behavioral domains, then converted to standardized, weighted principle component scores (PCS) for each domain. Multivariate logistic regression models built on cognitive domains found the immediate recall and psychomotor domains to best predict diagnostic group membership. In a separate model limited to behavioral data, the depressed mood domain best predicted group membership. The combination of immediate memory deficits, psychomotor slowness and depression have also been found in Vascular Dementia (VaD), suggesting that the pattern of deficits in Vascular CIND and VaD neuropsychological deficits are similar. This cognitive and behavioral pattern similarity supports the hypothesis that Vascular CIND lies on a continuum between NCI and VaD.

The Black Seventh-Day Adventist exploratory health study.

African Americans are at high risk for stroke and dementia. Modifications of lifestyle, however, might lower this risk. The Seventh-Day Adventist (SDA) Church encourages both spiritual adherence and a healthy lifestyle. Members are encouraged to exercise and are discouraged from smoking, drinking alcoholic or caffeinated beverages, or eating meat. The present study describes an exploratory project in 2 Black SDA congregations (N = 82) designed to characterize the lifestyle, dietary, and spiritual health habits of these congregations, and to test the feasibility of collecting such information in the Black SDA community at large. Three separate data collection methods are described and evaluated. Data demonstrate that the sample differs significantly from the African-American community at large in dietary, lifestyle, and spiritual health habits. The Black SDA community represents a unique opportunity to test the effects of diet, lifestyle, and spirituality on risk for stroke and dementia.