Population Health Solutions for Assessing Cognitive Impairment in Geriatric Patients

In December 2017, the National Academy of Neuropsychology convened an interorganizational Summit on Population Health Solutions for Assessing Cognitive Impairment in Geriatric Patients in Denver, Colorado. The Summit brought together representatives of a broad range of stakeholders invested in the care of older adults to focus on the topic of cognitive health and aging. Summit participants specifically examined questions of who should be screened for cognitive impairment and how they should be screened in medical settings. This is important in the context of an acute illness given that the presence of cognitive impairment can have significant implications for care and for the management of concomitant diseases as well as pose a major risk factor for dementia. Participants arrived at general principles to guide future screening approaches in medical populations and identified knowledge gaps to direct future research. Key learning points of the summit included: recognizing the importance of educating patients and healthcare providers about the value of assessing current and baseline cognition; emphasizing that any screening tool must be appropriately normalized and validated in the population in which it is used to obtain accurate information, including considerations of language, cultural factors, and education; and recognizing the great potential, with appropriate caveats, of electronic health records to augment cognitive screening and tracking of changes in cognitive health over time. Summit Participants Deb Adler(1), Christopher Alban, MD, MBA(2), Mark Bondi, PhD(3), Michelle Braun, PhD(4), Xavier Cagigas, PhD(5), Morgan Daven(6), Robert L. Denney, PsyD(7,8), Lisa Drozdick, PhD(9), Norman L. Foster, MD(10,11), Ula Hwang, MD(12–15), Laurie Ivey, PsyD(16), Grant Iverson, PhD(7,17), Joel Kramer, PsyD(18), Laura Lacritz, PhD(7,19), Melinda Lantz, MD(20), Lisa Latts, MD, MSPH, MBA(21), Shari M. Ling, MD(22), Ana Maria Lopez, MD(23–26), Michael Malone, MD(27,28), Lori Martin-Plank, PhD, MSN, MSPH, RN(29), Katie Maslow, MSW(30), Don Melady, MSc(Ed), MD(31–33), Melissa Messer(34), John Meyers, PsyD(7), Charles E. McConnel, PhD(19), Randi Most, PhD(36), Margaret P. Norris, PhD(37), William Perry, PhD(7,85,39), Neil Pliskin, PhD(40), David Shafer, MBA(41), Nina Silverberg, PhD(42), Tresa Roebuck-Spencer, PhD(43,44), Colin M. Thomas, MD, MPH(45), Laura Thornhill, JD(46), Jean Tsai, MD, PhD(10,47), Nirav Vakharia, MD(48), Martin Waters, MSW(49) Organizations Represented Alzheimer’s Association, Chicago, IL AMA/CPT Health Care Professionals Advisory Committee, Chicago, IL American Academy of Clinical Neuropsychology (AACN), Ann Arbor, MI American Academy of Neurology (AAN), Minneapolis, MN American Association of Geriatric Psychiatry (AAGP), McLean, VA American Association of Nurse Practitioners (AANP), Austin, TX American Board of Professional Neuropsychology (ABN), Sarasota, FL American College of Emergency Physicians (ACEP), Philadelphia, PA American College of Physicians (ACP), Philadelphia, PA American Geriatrics Society (AGS), New York, NY American Psychological Association (APA), Washington, DC Beacon Health Options, Boston, MA Canadian Association of Emergency Physicians, Ottawa, ON, Canada Collaborative Family Healthcare Association (CFHA), Rochester, New York Gerontological Society of America, Washington, DC Hispanic Neuropsychological Society (HNS), Los Angeles, CA IBM Watson Health, Denver, CO International Federation of Emergency Medicine, West Melbourne, Australia International Neuropsychological Society (INS), Salt Lake City, UT National Academy of Neuropsychology (NAN), Denver, CO Optum of UnitedHealth Group, Minneapolis, MN Pearson, New York City, New York Psychological Assessment Resources, Inc, Lutz, FL Society for Clinical Neuropsychology, Washington, DC U.S. Department of Veterans Affairs, Washington, DC *Please note that participation in the Summit does not constitute organizational endorsement of this report