New tool evaluates "everyday" cognition
■ Growing numbers of elderly likely will lead to higher rates of dementia, making earlier detection a priority.
By Susan J. Landers — Posted July 21, 2008
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Washington -- A new "everyday" cognition scale may allow physicians to assess who among their aging patients is showing early signs of dementia.
The 39-question scale, published in the July Neuropsychology, is designed to be filled out by a patient's spouse, friend or relative. These observers are asked to compare an individual's current ability to carry out a number of common tasks to his or her ability to do so a decade earlier.
The tasks were chosen to reflect the state of a patient's memory, language, visual-spatial, perceptual and executive functioning abilities, all of which can decline with age.
As a growing portion of the population is reaching an advanced age -- the Pew Research Center predicts that the nation's elderly population will more than double from 2005 through 2050 -- physicians likely will give even more thought to patients' risks for developing Alzheimer's disease and other dementias.
Recognizing that dementia already is a major public health problem, the AMA has developed a "Practical Guide for the Primary Care Physician on the Diagnosis, Management and Treatment of Dementia." The guide also includes characteristics of typical aging versus dementia.
Functional lapses are a warning sign
A flagging ability to organize financial records or remember a few grocery items without a list could signal signs of disease, theorized researchers at the University of California, Davis, and the Veterans Affairs Northern California Health Care System.
"We were interested in designing a scale that picked up early changes," said Sarah Tomaszewski Farias, PhD, study lead author and an assistant professor of neurology at UC Davis.
While other scales come into play after an individual has lost a considerable amount of cognitive ability, the Everyday Cognition, or ECog, scale, differs by attempting to focus on more subtle changes that occur earlier.
Functional abilities included
The ECog scale also is designed to recognize deficiencies in functional abilities. "Some studies have shown that those with mild functional changes are more likely to develop severe dementia in the future," she said.
The researchers hope to use their scale in a longitudinal study. "We know a lot about how cognitive changes progress in Alzheimer's disease. It starts with memory [loss], and language problems develop, but we really don't understand how the functional changes develop," Farias said.
In testing their ECog scale, researchers collected data on the functional and mental abilities of 576 older adults, average age about 77, who were evaluated at a university-based Alzheimer's research center.
Of these adults, 174 were determined to be cognitively normal, 126 were mildly cognitively impaired and 276 were diagnosed with dementia.
They also generated a series of items describing everyday functions. Through pilot studies, they narrowed an initial list of 138 items to the 39 used in the study to validate the design of the ECog scale.
The scale was shown to be valid in several ways, researchers say. Its results appeared to measure the same things as established tests and duplicated participants' medical diagnoses.
By differentiating among people with normal cognition, mild cognitive impairment and dementia, the ECog scale demonstrated sensitivity to early functional changes in people with mild cognitive impairment, they wrote. The researchers said they believe that the scale shows great promise as a screening tool.
Mild problems are detectable
The ECog scale also distinguished between people diagnosed with mild impairment in memory only and those mildly impaired in other areas. This sensitivity could help with differential diagnoses of underlying brain disease, they said.
Because the ECog scale also can detect early functional problems, researchers hope it will shed light on how such problems emerge and, over time, lead to obvious disability.
More immediately, the ECog scale can help doctors and others identify cognitive impairment more effectively and better understand the "limits, care needs and interventions appropriate to individuals," they wrote.
For example, they suggest, making more lists, relying more on calendars and timers, and learning memory techniques for new names or ways to organize household papers in a new way might enable independent functioning for a longer time.