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New Dementia Screening Tool Overcomes Cultural Bias

Crain’s Health Pulse, May 31, 2018

Montefiore Health System and Albert Einstein College of Medicine have piloted a dementia-screening tool that has patients recall images rather than words. It accurately detects early signs of cognitive decline regardless of a person's ethnic background, native language or education level, according to research published Wednesday in the Journal of the American Geriatrics Society.

The Picture-Based Memory Impairment Screening, which takes about four minutes to administer, can be used by primary-care physicians, nurses and other health professionals to detect early signs of Alzheimer's disease and other forms of dementia, according to the developer of the tool, Dr. Joe Verghese, director of Montefiore Einstein Center for the Aging Brain.

"The purpose of the tool is to raise a red flag so that doctors seeing the patient might be aware something is going on that needs further testing," he said.

About 28 million of the 36 million people with dementia worldwide are not diagnosed, according to the World Alzheimer Report.

The picture tool, which seeks to overcome inaccurate results caused by cultural biases and poor education levels, has been piloted in India, Japan and New York. A patient in India, for example, might be presented with the picture of a monkey, a common animal there, while a patient in the Bronx might be asked to identify a picture of a horse. Individuals are asked to place four pictures into categories, such as body parts or animals, and then recall them later on in the session.

Verghese said the researchers are setting up a clinical trial, funded by the National Institutes of Health, to determine if the tool, coupled with a decision tree for physicians, would improve dementia care in a primary-care setting.

The researchers hope the tool will enable physicians to spot cognitive decline when intervention can make a difference, Verghese said. Early identification can help people get into clinical trials and start treatment to manage symptoms, as well as enable them to make long-range care plans.

Early detection might also prompt a physician to suggest lifestyle changes, such as diet and exercise, that affect cognition. "You might be able to do something to impact their quality of life and improve their functionality for as long as possible," Verghese said. —R.S.