title: Routine cognitive screening in a neurology practice: Effect on physician behavior.
abstract: BACKGROUND
  Alzheimer disease is one of the most prevalent and costly neurologic disorders. American Academy of Neurology guidelines call for diagnosis and treatment when dementia is present, but provide no specific instruction relating to cognitive screening.
  
  
  METHODS
  Our center piloted a cognitive screening initiative using the Mini-Cog, which was administered to all neurology patients aged ≥70 years without a history of a cognitive disorder.
  
  
  RESULTS
  There was a 37.4% screen positive rate on the Mini-Cog. The percentage of patients with subjective memory complaints did not differ between patients screening positive vs negative on the Mini-Cog. Prospective analysis over an 18-month postscreening period showed that individuals screening positive for cognitive impairment were 10 times more likely to have follow-up cognitive assessment by the provider (p< 0.0001), almost 3 times more likely to be referred for neuropsychological testing (p= 0.003), and 3 times more likely to receive a diagnosis of cognitive impairment or dementia (p< 0.0001) compared to those screening negative. Diagnosis of a cognitive disorder, referral to a cognitive specialty clinician, and prescription of cognitive-enhancing medications were no more frequent than was observed in a randomized trial of screening in primary care, and evidence of neurologists' actions relevant to cognitive impairment was found in a minority of individuals screening positive.
  
  
  CONCLUSIONS
  Further studies are needed to better understand factors influencing neurologist actions in the evaluation and treatment of cognitive impairment.
authors.affiliation: HealthPartners Center for Memory and Aging (MR, TB, LRH), St. Paul; Department of Neurology (MR, JM), University of Minnesota Medical School, Minneapolis; Geriatric Research, Education and Clinical Center (GRECC) (JM), Minneapolis VA Health Care System, MN; the University of Washington School of Nursing (SB), University of Washington School of Medicine, Seattle; and HealthPartners Institute for Research and Education (LRH, AW, LS), Bloomington, MN.
authors.forename: Michael
authors.initials: M
authors.lastname: Rosenbloom
authors.affiliation: HealthPartners Center for Memory and Aging (MR, TB, LRH), St. Paul; Department of Neurology (MR, JM), University of Minnesota Medical School, Minneapolis; Geriatric Research, Education and Clinical Center (GRECC) (JM), Minneapolis VA Health Care System, MN; the University of Washington School of Nursing (SB), University of Washington School of Medicine, Seattle; and HealthPartners Institute for Research and Education (LRH, AW, LS), Bloomington, MN.
authors.forename: Soo
authors.initials: S
authors.lastname: Borson
authors.affiliation: HealthPartners Center for Memory and Aging (MR, TB, LRH), St. Paul; Department of Neurology (MR, JM), University of Minnesota Medical School, Minneapolis; Geriatric Research, Education and Clinical Center (GRECC) (JM), Minneapolis VA Health Care System, MN; the University of Washington School of Nursing (SB), University of Washington School of Medicine, Seattle; and HealthPartners Institute for Research and Education (LRH, AW, LS), Bloomington, MN.
authors.forename: Terry
authors.initials: T
authors.lastname: Barclay
authors.affiliation: HealthPartners Center for Memory and Aging (MR, TB, LRH), St. Paul; Department of Neurology (MR, JM), University of Minnesota Medical School, Minneapolis; Geriatric Research, Education and Clinical Center (GRECC) (JM), Minneapolis VA Health Care System, MN; the University of Washington School of Nursing (SB), University of Washington School of Medicine, Seattle; and HealthPartners Institute for Research and Education (LRH, AW, LS), Bloomington, MN.
authors.forename: Leah R
authors.initials: LR
authors.lastname: Hanson
authors.affiliation: HealthPartners Center for Memory and Aging (MR, TB, LRH), St. Paul; Department of Neurology (MR, JM), University of Minnesota Medical School, Minneapolis; Geriatric Research, Education and Clinical Center (GRECC) (JM), Minneapolis VA Health Care System, MN; the University of Washington School of Nursing (SB), University of Washington School of Medicine, Seattle; and HealthPartners Institute for Research and Education (LRH, AW, LS), Bloomington, MN.
authors.forename: Ann
authors.initials: A
authors.lastname: Werner
authors.affiliation: HealthPartners Center for Memory and Aging (MR, TB, LRH), St. Paul; Department of Neurology (MR, JM), University of Minnesota Medical School, Minneapolis; Geriatric Research, Education and Clinical Center (GRECC) (JM), Minneapolis VA Health Care System, MN; the University of Washington School of Nursing (SB), University of Washington School of Medicine, Seattle; and HealthPartners Institute for Research and Education (LRH, AW, LS), Bloomington, MN.
authors.forename: Logan
authors.initials: L
authors.lastname: Stuck
authors.affiliation: HealthPartners Center for Memory and Aging (MR, TB, LRH), St. Paul; Department of Neurology (MR, JM), University of Minnesota Medical School, Minneapolis; Geriatric Research, Education and Clinical Center (GRECC) (JM), Minneapolis VA Health Care System, MN; the University of Washington School of Nursing (SB), University of Washington School of Medicine, Seattle; and HealthPartners Institute for Research and Education (LRH, AW, LS), Bloomington, MN.
authors.forename: John
authors.initials: J
authors.lastname: McCarten