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

3. Cognitive Screening: A Clinical Perspective

4. Our Cognitive Screen is not a diagnostic test for Dementia

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

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

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

8. Other tests MRI showing white matter changes Lacunar infarcts
Cerebral atrophy

9. White matter changes

10. White Matter Hyperintensities
Endpoint Hazard ratio
Stroke
Dementia
Death
BMJ 2010;341:c3666

11. Cerebral Atrophy

12. 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

13. 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

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

15. Who should get cognitive screen?

16. Age Influence on Prevalence of Dementia

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

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