Rubin Becker MD FRCP© Associate Professor McGill University Medical Consultant Manulife and OptimumRe.

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Presentation transcript:

Rubin Becker MD FRCP© Associate Professor McGill University Medical Consultant Manulife and OptimumRe

Cognitive Screening: A Clinical Perspective

Our Cognitive Screen is not a diagnostic test for Dementia

Look for other clues in APS Genetic Vascular risk factors Hints of progressive cognitive loss Other investigations

Vascular Risk Genetic Obesity/lifestyle Lipids BP Smoker DM Heart disease

Progressive Cognitive Loss Clues Change in mood (pseudodepression) Change in function Change in behavior Move to more supportive setting

Other tests MRI showing white matter changes Lacunar infarcts Cerebral atrophy

White matter changes

White Matter Hyperintensities Endpoint Hazard ratio Stroke 3.3 Dementia 1.9 Death 2.0 BMJ 2010;341:c3666

Cerebral Atrophy

Cerebral Atrophy and White Matter Hyperintensity Measuring Cerebral Atrophy and White Matter Hyperintensity Burden to Predict the Rate of Cognitive Decline in Alzheimer Disease Adam M. Brickman, PhD; Lawrence S. Honig, MD, PhD; Nikolaos Scarmeas, MD; Oksana Tatarina, BA; Linda Sanders, BA; Marilyn S. Albert, PhD; Jason Brandt, PhD; Deborah Blacker, MD, ScD; Yaakov Stern, PhD

Cerebral Atrophy and White Matter Hyperintensity cont’d Longitudinal study of mild AD patients (Predictors study) 84 patients Followed every 6 months Modified MMSE decline correlated with WMC and atrophy Synergistic effect of both on future decline of AD

Mild Cognitive Impairment No evidence of dementia No functional impairment Subjective “forgetfulness” Slight impairment on cognitive test 15% per year progress to dementia

Who should get cognitive screen?

Age Influence on Prevalence of Dementia

Which is the best cognitive test? Which is the best cognitive screening test?

Insurers requirements Client acceptability Ease of administration Reliable High sensitivity and specificity Low cost Ideal if able to administer by phone interview