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A Systematic Evidence Review of the Signs and Symptoms of Dementia and Brief Cognitive Tests Available in VA

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A Systematic Evidence Review of the Signs and Symptoms of Dementia and Brief Cognitive Tests Available in VA

Investigators: Devan Kansagara, MD and Michele Freeman, MPH.

Evidence-based Synthesis Program (ESP) Center, Portland VA Medical Center

Washington (DC): Department of Veterans Affairs; April 2010.


Download PDF: Complete Report, Executive Summary, Report, Appendices

Summary / Overview

The Veterans Health Administration (VHA) Office of Geriatrics and Extended Care (OGEC) in Patient Care Services has primary responsibility for coordination and direction of VHA dementia initiatives. OGEC convened an interdisciplinary Dementia Steering Committee (DSC) in December 2006, with the goal of making recommendations on comprehensive, coordinated care for Veterans with dementia.

The systematic literature review addressed the following key questions:

  1. What signs and symptoms should prompt VA providers to assess cognitive function as part of an initial diagnostic workup for dementia?
  2. Which measures of cognitive function provide the optimal sensitivity, specificity, and time to completion among the measures available to VA providers?
  3. What are adverse consequences of using these measures?

Excerpt

The Veterans Health Administration (VHA) Office of Geriatrics and Extended Care (OGEC) in Patient Care Services has primary responsibility for coordination and direction of VHA dementia initiatives. OGEC convened an interdisciplinary Dementia Steering Committee (DSC) in December 2006, with the goal of making recommendations on comprehensive, coordinated care for Veterans with dementia.

The DSC requested VA HSR&D's Evidence-based Synthesis Program (ESP) to review evidence on selected topics to assist with DSC planning efforts.

Broad-based dementia screening programs have not been widely advocated given lack of evidence that earlier detection will improve health outcomes. Improving the accuracy of case-finding techniques depends both on an understanding of signs and symptoms that help distinguish patients with dementia from those without, and the reliability of brief assessment tests that can be incorporated into primary care practice when appropriate. The purpose of this report is to systematically review the evidence on identifying the signs and symptoms of dementia in undiagnosed patients, and evaluating several brief mental status measures currently being used in VHA.


See also