Currently the USPSTF has a grade I for screening cognitive impairment. Is there anything that can alert the patient, their caregiver, or other family members to bring awareness to cognitive impairment early in the process so the patient can be assessed earlier in the disease process? Is there something that can widen public awareness much like the Stroke Heroes act FAST video and poster? Or even a flyer like the intimate partner violence pamphlets with safety numbers shown in many hospital bathrooms?
Much like the FINGER study suggests (1st link below), it would be a good idea to capture a wide array of factors to screen for cognitive impairment as there does not seem to be a single factor that leads to dementia.
The first clue for families may be falling. Falling and cognitive impairment seem to be linked (2nd/3rd link below). Perhaps this can be utilized as an easy (and relatively low cost) screening tool for families as a way for them to raise the question "Was the fall due to a brewing underlying cognitive decline" to their primary care physician. This may be a fairly simple way for patients to advocate for themselves to have their PCP to do further investigation.
Other aspects can utilize younger family members to get involved as well. If we can encourage kids to ask their grandparents or middle-aged to elderly family friends, this would broaden the net of people we could screen. This would also be nice to have multigenerational integration. Outreach to kids can be through their teachers with extra credit/assignments, group sessions in class, or even assemblies with the entire school. Some sample items on a form might look as followed:
1) Think of one of your favorite games to play. Try to teach your [grandparent, loved one, etc] to play. Are they able to do it easily? This may test memory and problem solving skills.
2) When you are walking around with them, are they able to keep up with you? Have they fallen? To test for mobility, get an idea of their physical well being.
3) Do you find that you haven't been seeing them as much? This may speak to depression.
4) Have you noticed you are not able to understand them as well? To get a better idea about aphasia, thought blocking, or any language difficulties the patient may be having.
Similar flyers or inserts can be put near or in boxes of home blood pressure monitors or glucometers to screen patients with comorbid hypertension or diabetes. We could even make the questions in yes or no form, so they can easily self score or do this with their spouse.
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