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Vital Brain Aging Clinical Path Overview

  • Educate

  • Assess

  •  

    The Methods

  • Diagnosis

  • Treatment













Select Assessment Method

There are three pathways from which you can choose how best to have your patients assessed for cognitive deficits. Each pathway is equally effective and physicians should choose the one that best fits within the scope and capabilities of their practice.

Three Pathways to Assess You Patients

  1. You may perform an office-based assessment and earn reimbursement.
  2. You may refer to your usual channels for neuropsychological evaluation.
  3. You may refer to the Vital Brain Aging memory assessment service.

Office Based Assessment

Assessing memory in your office involves using a cognitive assessment instrument to objectively measure the patient's performance on a series of cognitive tasks, and then scoring their performance in accordance with established means for their demographic peer group. There are many instruments available and several are briefly described below.

Recommended:
  • MCI Screen - This is the tool recommended, but not required, for participating physicians in the Vital Brain Aging program. It is a ten-minute, electronically scored test of short-term memory and has the highest sensitivity for detecting mild cognitive impairment among all tests in the published literature. It can be administered by office staff and is attractively reimbursed by Medicare and most private payers. It requires Internet connectivity at the point of care and a licensing fee. Instructions for establishing an account with a free trial are available at www.mccare.com.

Alternative Approaches:
  • Mini-Mental State Exam (MMSE) - This was the original standard for primary care assessment but is somewhat outdated and no longer reimbursed by Medicare and other payers. The primary advantage is that its 30-point scale is well known. The disadvantages are that it was designed to assess dementia (not mild cognitive impairment) and it is not sensitive for detecting subtle decline. Furthermore, it must be scored manually and there are no published norms to adjust for patient age and education level. It takes about ten minutes to administer. The testing materials and scoring instructions can be purchased through www.parinc.com.
  • Clock Drawing Test - This is another well-known standard for assessing severe impairment and dementia (mild cognitive impairment). The scoring is somewhat more subjective than the MMSE and it has equally poor sensitivity for detecting subtle decline. It is not generally reimbursed but it is free to use and usually quick to administer, taking from 3 to 6 minutes. A key point of difference is that this tool tests visuo-spatial skills whereas most of the more common tools assess memory.
  • Montreal Cognitive Assessment (MoCA) - This is a combination of many brief neuropsychological tests that have been assembled into a battery with a 30-point scale like that of the MMSE. It is a relatively new test with growing validation for detecting dementia but minimal data showing an ability to detect mild cognitive impairment. For use in a clinical setting, the MoCA requires the purchase of a licensing agreement. Instructions for administering and scoring the MoCA are available at www.mocatest.org.

Neuropsychologic Evaluation

If you currently refer patients with memory complaints to a particular source for neuropsychological evaluation, there is no compelling reason to disrupt that established approach. However, you might consider using a simple, office-based assessment to determine which patients should be referred.

The most important aspect of these guidelines is that you are vigilant in identifying subtle complaints and ushering the patient forward along some constructive pathway toward a high standard of care.

 

OCVBA Memory Assessment

You may wish to refer your patients to the Vital Brain Aging Memory Assessment Service at Hoag Hospital. Through this pathway, your referred patients will be assessed with the MCI Screen and the test results will be provided to you so that you can decide appropriate next steps in accordance with those results. The Vital Brain Aging has also assembled a panel of experts who can receive specialty referrals as needed.

For more information, please contact:
Education and Screening Coordinator
Phone: (949)764-6288