Introduction

Alzheimer’s disease and related dementias (ADRD) and mild cognitive impairment (MCI) are often under-recognized in the community. MCI/ADRD screening could offer benefits such as early treatment, research participation, lifestyle modification, and advanced care planning. To date, there are no clear guidelines regarding the benefits vs. harms of dementia screening or whether a dementia screening program could be successful.

Methods

A community-based study was conducted to evaluate an MCI/ADRD screening program and determine what older adults would do with the information. Measures of cognition, physical health, functionality, and mood were collected. Participants met with a health professional, were given screening results with recommendations, and then contacted 60 days later to determine what was done with the results. Logistic regression models were used to build predictive models.

Results

Participants (n = 288) had a mean age of 71.5±8.3y, mean education of 13.3±4.8y, and were 70% female, 67% White, 26% African American, and 48% Hispanic. After 60 days, 75% of participants were re-contacted; 54% shared results with family, 33% shared results with health care providers (HCPs), and 52% initiated behavioral change. Among participants sharing results with HCPs, 51% reported HCPs did not follow-up on the results, and 18% that HCPs did not show any interest in the screening visit or its results. Predictors of sharing results with HCPs were elevated hemoglobin A1C (OR = 1.85;95%CI:1.19–2.88), uncontrolled hypertension (OR = 2.73;95%CI:1.09–6.83), and mobility issues (OR = 2.43;95%CI: 1.93–5.54). Participant behavioral changes included lifestyle modification (58%), social engagement (10%), cognitive stimulation (5%), and advanced care planning (4%). The most significant predictors of sharing with family were better overall mental health (OR = 0.19; 95%CI: 0.06–0.59) and better physical function (OR = 0.38; 95%CI: 0.17–0.81).

Discussion

MCI/ADRD screening was well-received by a diverse community sample. Participants showed interest in sharing the results with their family and HCPs and many attempted behavioral change. While HCPs did not always act on screening results, 25% ordered further testing and evaluation. Efforts need to be directed toward (1) increasing self-efficacy of older adults to discuss screening results with their HCPs, and (2) educating HCPs on the value of early detection of MCI/ADRD. Community dementia screening programs can increase MCI/ADRD detection and improve patient-centered outcomes and medical decision-making.

中文翻译：

---

老年痴呆症筛查计划的结果如何。

介绍

阿尔茨海默氏病和相关的痴呆症（ADRD）和轻度认知障碍（MCI）通常在社区中被忽视。MCI / ADRD筛查可以提供诸如早期治疗，研究参与，生活方式改变和高级护理计划等好处。迄今为止，对于痴呆症筛查的益处与弊端或痴呆症筛查计划能否成功，尚无明确的指南。

方法

进行了一项基于社区的研究，以评估MCI / ADRD筛查计划，并确定老年人将如何处理这些信息。收集认知，身体健康，功能和情绪的指标。参加者与卫生专业人员会面，获得筛查结果并提供建议，然后在60天后联系以确定对结果的处理方式。逻辑回归模型用于建立预测模型。

结果

参与者（n = 288）的平均年龄为71.5±8.3y，平均受教育程度为13.3±4.8y，女性为70％，白人为67％，非裔美国人为26％，西班牙裔为48％。60天后，重新联系了75％的参与者；54％与家人共享结果，33％与医疗保健提供者（HCP）分享结果，52％引发了行为改变。与HCP共享结果的参与者中，有51％的人报告了HCP没有对结果进行跟进，而18％的HCP对筛选访问或其结果没有兴趣。与HCP共享结果的预测因素是血红蛋白A1C升高（OR = 1.85; 95％CI：1.19–2.88），高血压不受控制（OR = 2.73; 95％CI：1.09–6.83）和活动性问题（OR = 2.43; 95％ CI：1.93-5.54）。参与者的行为改变包括生活方式改变（58％），社交参与（10％），认知刺激（5％），和高级护理计划（4％）。与家人共享的最重要预测指标是总体心理健康状况更好（OR = 0.19； 95％CI：0.06-0.59）和身体机能更好（OR = 0.38； 95％CI：0.17-0.81）。

讨论区

MCI / ADRD筛查得到了广泛的社区样本的好评。参与者表现出了与家人和HCP分享结果以及许多尝试改变行为的兴趣。尽管HCP并不总是根据筛选结果起作用，但25％的人下令进行进一步的测试和评估。需要做出努力，以（1）提高老年人的自我效能，与他们的HCP讨论筛查结果，以及（2）对HCP进行早期检测MCI / ADRD的价值的教育。社区痴呆症筛查计划可以提高MCI / ADRD检测率，并改善以患者为中心的结局和医疗决策。