Cognitive Assessment of Elderly Primary Care Patients

描述（由申请人提供）：相当数量的老年人随着年龄的增长而经历认知能力下降。认知功能障碍的原因包括从阿尔茨海默病（AD）的破坏性影响到大多数老年人所描述的正常轻度健忘。然而，绝大多数老年人的认知功能障碍与潜在可治疗的疾病有关，例如甲状腺疾病、肾脏疾病或抑郁症。大多数美国老年人只在普通诊所接受医疗保健，即使是轻微的认知功能障碍也会影响对医疗干预的坚持，并损害决策。然而，大多数初级保健医生（PCP）不筛查认知困难，大多数老年患者不报告认知问题。在办公室就诊时识别认知障碍将允许更早的转诊进行诊断检查和更早更适当的治疗。迄今为止，还没有研究检验在初级保健环境中提供认知筛查的有效性。我们建议在四个参与的社区实践中使用标准化的神经心理学工具筛选1000名65岁以上的患者是否存在认知功能障碍。这四名医生将被随机分配到“照常治疗”（TAU）组或“认知报告”（CR）组。对于CR组的患者，认知结果将提供给他们的PCP，同时支持教育活动。我们将对两组进行为期两年的随访，以评估感兴趣的结果（例如认知变化、服务利用、药物和药物依从性、PCP办公室和急诊室就诊、住院、专家转诊、死亡率等）。我们假设，如果PCP意识到认知困难，他/她将调整患者互动和治疗计划，以适应患者的功能水平，从而改善临床实践和临床结果。最后，我们计划研究一个简短的计算机化认知测试。这样的测试可以在PCP办公室进行常规管理，使初级保健环境中的认知数据易于获得。

DESCRIPTION (provided by applicant): Significant numbers of older individuals experience cognitive decline with aging. The causes of cognitive dysfunction range from the devastating effects of Alzheimer's disease (AD) to normal mild forgetfulness described by most older individuals. However, the vast majority of cognitive dysfunction in older persons is related to potentially treatable disorders e.g. thyroid disease, renal disease or depression. Most older Americans receive their health care solely within the general practice setting and even mild cognitive dysfunction can impact adherence with medical interventions and impair decision-making. However, most primary care physicians (PCP) do not screen for cognitive difficulties and most older patients do not report cognitive problems. Identification of cognitive impairment at an office visit would permit earlier referral for diagnostic work-up and earlier and more appropriate treatment. To date, no studies have examined the effectiveness of providing cognitive screening in the primary care setting. We propose to screen 1000 patients age 65+ within four participating community practices for the presence of cognitive dysfunction using standardized neuropsychological tools. The four physician practices will be randomly assigned to either a "treatment as usual" (TAU) or "Cognitive Report" (CR) group. For the patients in the CR group the cognitive results will be provided to their PCP together with supporting educational activities. We will follow both groups over two years to assess outcomes of interest (e.g. change in cognition, service utilization, medications and medication adherence, PCP office and ER visits, hospitalizations, specialist referrals, mortality etc). We hypothesize that if the PCP is aware of cognitive difficulties he/she will modify patient interactions and treatment plans to accommodate the patient's level of functioning resulting in improved clinical practice and clinical outcomes. Finally, we plan to investigate a brief computerized test of cognition. Such a test could be routinely administered in PCP offices, making cognitive data readily available in the primary care setting. The results of this study will have both immediate and long-term practical and public health significance. First, this study will immediately provide PCP's with the knowledge and ability to identify, and therefore treat, patients with (1) early AD, slowing the progression of cognitive decline from the earliest point; (2) potentially reversible causes of cognitive decline thus reducing the added burden of cognitive deficits; and (3) mild cognitive dysfunction which may affect ability to follow medication regimens or treatment plans. Second, this study will help prepare PCP's to identify and manage older patients with cognitive decline as improved treatments for AD and other cognitive disorders become available over the next three-five years.