Screen for Early Diagnosis of Mild Cognitive Impairment due to AD

Early diagnosis is critical¹

It may now be possible to slow progression of cognitive decline due to AD, but early detection is key. The time between MCI and later stages is limited, making early detection and referral to a specialist critical.¹

Consistent screening is essential

Cognitive screening for patients aged 65 years and older, at the annual wellness visit, is key to detecting MCI due to AD and planning an appropriate treatment path.¹

Only 2.4%

of Medicare beneficiaries eventually diagnosed with AD or a related disorder received a cognitive assessment during an annual wellness visit, highlighting the need for consistent screening and identification of early-stage patients²

Annual visit screening tips

MoCA=Montreal Cognitive Assessment⁴

Designed based on tools commonly used in cognitive screening, with the raw score adjusted for education
30 questions covering 8 domains
Score range: 0 to 30: >26=normal

Administration time: ^~10 minutes

Administrator: MoCA is designed to be administered to patients by qualified HCPs

Mini-Cog©=Quick Screening for Early Dementia Detection^3,5

Easy to administer to non-English speakers
Less biased by low education and literacy than other tools
Score range: 0 to 5: 0-2=higher likelihood of cognitive impairment, 3-5=lower likelihood of dementia

Administration time: 2-4 minutes

Administrator: Mini-Cog© is designed to be administered to patients by qualified HCPs

AD8=8-item Interview to Differentiate Aging and Dementia⁶

Rates change in cognition and function
Phone or in-person administration
Score range: 0 to 8: 0 or 1=not demented. 2-8=demented

Administration time: ^~3 minutes

Administrator: AD8 is designed to be administered to a care partner by qualified health care providers (HCPs)

SLUMS=Saint Louis University Mental Status Examination⁷

Educational bias is minimized
Scoring similar to the MMSE^® with additional tasks
Score range: 0 to 30: 1-20=dementia, 21-26=MNCD, 27-30=normal

Administration time: ^~7 minutes

Administrator: SLUMS is designed to be administered to patients by qualified HCPs

MMSE=Mini-Mental State Examination; MNCD=mild neurocognitive disorder.

*This is not a comprehensive list of tools for assessing cognitive function and is not intended to recommend any particular tool.

Catching MCI due to AD early, may offer an opportunity for intervention.¹

Note and assess MCI

Understand the signs of MCI

Patients in the MCI due to AD stage still perform activities of daily living independently, though may experience mild but detectable impacts on more complex activities of daily life.¹ These patients will show evidence of cognitive decline from baseline and test abnormally or impaired by objective cognitive tests.³

Through direct observation and discussion with patients and care partners, make note of any of the following common symptoms of early cognitive decline¹:

Frequent poor judgment and decision making
Inability to manage finances
Losing track of time or the current season
Difficulty having a conversation
Losing items and being unable to backtrack or locate them

Changes in memory, language, and the ability to complete routine tasks may help guide your decision to administer a cognitive test.

Evaluate and rule out other causes of MCI

MCI can be caused by several reasons, but more than 60% of cases are due to AD. Before testing for Aβ pathology, rule out the following^1,7,8:

Vitamin B₁₂ deficiency
Thyroid diseases
Tumors
Evidence of small or large strokes
Damage from severe head trauma
Fluid buildup in the brain

Medications/comorbidities
Psychiatric disorders
Sleeping issues
Hearing problems
Alcohol or drug abuse

Order a cognitive workup

Perform screening for MCI

While no test represents the benchmark for MCI validation, the following neurocognitive tools* are sensitive to MCI due to AD and mild AD dementia, and may aid in early identification:

MoCA=Montreal Cognitive Assessment⁴
AD8=8-item Informant Interview to Differentiate Aging and Dementia⁶
SLUMS=Saint Louis University Mental Status Examination⁷

*This is not a comprehensive list of tools for assessing cognitive function and is not intended to recommend any particular tool.

Consider screening for amyloid beta pathology with a new blood biomarker (BBM) test. Aβ is a biomarker of AD that accumulates years before late-stage symptoms appear. Aβ concentration may be measured via BBMs in symptomatic individuals and may aid in the collection of evidence to triage a patient to a specialist.^1,9

Weigh results and refer

Refer patient to a specialist if evidence suggests need for further testing

BBM tests measure ratio of Aβ₄₂ and Aβ₄₀ and assesses levels of Aβ in a patient’s plasma. In addition to Aβ, some tests also measure phosphorylated tau proteins in plasma with high accuracy and correlate with AD pathology. These test results can indicate the need for further evaluation to verify an AD diagnosis.⁹

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References: 1. Alzheimer’s Association. 2023 Alzheimer’s disease facts and figures. Alzheimers Dement. 2023;19(4):1598-1695. 2. GAO. Medicare cognitive assessments: utilization tripled between 2018 and 2022, but challenges remain. Accessed January 28, 2024. https://www.gao.gov/assets/d24106328.pdf 3. Cordell CB, Borson S, Boustani M, et al. Alzheimer’s Association recommendations for operationalizing the detection of cognitive impairment during the Medicare annual wellness visit in a primary care setting. Alzheimers Dement. 2013;9(2):141-150. 4. Nasreddine ZS, Phillips NA, Bédirian V, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695-699. 5. Mini-Cog©. Scoring the Mini-Cog©. Quick screening for early dementia detection. Accessed February 19, 2024. https://mini-cog.com/scoring-the-mini-cog 6. Galvin JE, Roe CM, Powlishta KK, et al. The AD8: a brief informant interview to detect dementia. Neurology. 2005;65(4):559-564. 7. Knopman DS, Gottesman RF, Sharrett AR, et al. Mild cognitive impairment and dementia impairment prevalence: the Atherosclerosis Risk in Communities Neurocognitive Study. Alzheimers Dement (Amst). 2016;2(1):1-11. 8. Tariq SH, Tumosa N, Chibnall JT, Perry MH 3rd, Morley JE. Comparison of the Saint Louis University mental status examination and the mini-mental state examination for detecting dementia and mild neurocognitive disorder—a pilot study. Am J Geriatr Psychiatry. 2006;14(11):900-910. 9. Angioni D, Delrieu J, Hansson O, et al. Blood biomarkers from research use to clinical practice: what must be done? A report from the EU/US CTAD task force. J Prev Alzheimers Dis. 2022;9(4):569-579.

Screen for Early Diagnosis of Mild Cognitive Impairment due to AD

Early diagnosis is critical¹

Consistent screening is essential

of Medicare beneficiaries eventually diagnosed with AD or a related disorder received a cognitive assessment during an annual wellness visit, highlighting the need for consistent screening and identification of early-stage patients²

MoCA=Montreal Cognitive Assessment⁴

Mini-Cog©=Quick Screening for Early Dementia Detection^3,5

AD8=8-item Interview to Differentiate Aging and Dementia⁶

SLUMS=Saint Louis University Mental Status Examination⁷

Catching MCI due to AD early, may offer an opportunity for intervention.¹

Note and assess MCI

Understand the signs of MCI

Evaluate and rule out other causes of MCI

Order a cognitive workup

Perform screening for MCI

Weigh results and refer

Refer patient to a specialist if evidence suggests need for further testing

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Screen for Early Diagnosis of Mild Cognitive Impairment due to AD

Screen for Early Diagnosis of Mild Cognitive Impairment due to AD

Early diagnosis is critical1

Consistent screening is essential

Age 65+

Annual wellness visits

of Medicare beneficiaries eventually diagnosed with AD or a related disorder received a cognitive assessment during an annual wellness visit, highlighting the need for consistent screening and identification of early-stage patients2

Annual visit screening tips

Detecting MCI due to AD

What cognitive test should you use?

MoCA=Montreal Cognitive Assessment4

MoCA=Montreal Cognitive Assessment

Mini-Cog©=Quick Screening for Early Dementia Detection3,5

Mini-Cog=Quick Screening for Early Dementia Detection

AD8=8-item Interview to Differentiate Aging and Dementia6

AD8=8-item Interview to Differentiate Aging and Dementia

SLUMS=Saint Louis University Mental Status Examination7

SLUMS=Saint Louis University Mental Status Examination

Utilize information about patient office visits

Catching MCI due to AD early, may offer an opportunity for intervention.1

Note and Assess MCI

Note and assess MCI

Understand the signs of MCI

Evaluate and rule out other causes of MCI

Order a Cognitive Workup

Order a cognitive workup

Perform screening for MCI

Weigh results and refer

Weigh results and refer

Refer patient to a specialist if evidence suggests need for further testing

New care pathways are emerging to help identify appropriate patients for therapies that may slow progression of disease, but time is of the essence. Current treatment options include1:

Symptom management medications

Anti-amyloid treatments

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Early diagnosis is critical¹

of Medicare beneficiaries eventually diagnosed with AD or a related disorder received a cognitive assessment during an annual wellness visit, highlighting the need for consistent screening and identification of early-stage patients²

MoCA=Montreal Cognitive Assessment⁴

Mini-Cog©=Quick Screening for Early Dementia Detection^3,5

AD8=8-item Interview to Differentiate Aging and Dementia⁶

SLUMS=Saint Louis University Mental Status Examination⁷

Catching MCI due to AD early, may offer an opportunity for intervention.¹

New care pathways are emerging to help identify appropriate patients for therapies that may slow progression of disease, but time is of the essence. Current treatment options include¹: