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.

Contents

• PREFACE
• EXECUTIVE SUMMARY
  • BACKGROUND
  • METHODS
  • RESULTS
• BACKGROUND
• METHODS
  • TOPIC DEVELOPMENT
  • SEARCH STRATEGY
  • STUDY SELECTION
  • DATA ABSTRACTION
  • QUALITY ASSESSMENT
  • DATA SYNTHESIS
  • PEER REVIEW
• RESULTS
  • LITERATURE SEARCH
  • KEY QUESTION #1. What signs and symptoms should prompt VA providers to assess cognitive function as part of an initial diagnostic workup for dementia?
  • KEY QUESTION #2. Which measures of cognitive function provide the optimal sensitivity, specificity, and time to completion, among the measures available to VA providers?
  • KEY QUESTION #3. What are adverse consequences of using these measures?
• DISCUSSION
  • SIGNS AND SYMPTOMS OF DEMENTIA
  • BRIEF MEASURES OF COGNITIVE FUNCTION AVAILABLE TO VA
  • LIMITATIONS
  • FUTURE RESEARCH RECOMMENDATIONS
• REFERENCES
• APPENDIX A SEARCH STRATEGY
• APPENDIX B INCLUSION/EXCLUSION CRITERIA
• APPENDIX C QUADAS CRITERIA FOR EVALUATING DIAGNOSTIC ACCURACY STUDIES
• APPENDIX D PEER REVIEW COMMENTS
• APPENDIX E GLOSSARY

Prepared for: Department of Veterans Affairs, Veterans Health Administration, Health Services Research & Development Service, Washington, DC 20420. Prepared by: VA Evidence-based Synthesis Program (ESP) Center, Portland VA Medical Center, Portland, OR, Devan Kansagara, MD, Director.

Suggested citation:

Kansagara D and Freeman M. A Systematic Evidence Review of the Signs and Symptoms of Dementia and Brief Cognitive Tests Available in VA. VA-ESP Project #05-225; 2010.

This report is based on research conducted by the Evidence-based Synthesis Program (ESP) Center located at the Portland VA Medical Center, Portland, OR funded by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development. The findings and conclusions in this document are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs. No investigators have any affiliations or financial involvement (e.g., employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in the report.