New Tools for Assessment - PDF Document

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  1. New Tools for Assessment that Account for Comorbidity Esther Oh, M.D., Ph.D. Associate Professor Division of Geriatrics and Gerontology, Department of Medicine Psychiatry and Behavioral Sciences, and Pathology Johns Hopkins University School of Medicine

  2. Disclosures •Current funding •K23AG043504 (NIA/NIH) •R01AG057725-01(NIA/NIH) •Other financial relationships: None •Conflicts of interest: None 11/14/2017

  3. Overview •Sensory impairment in clinic setting •Screening tools to determine sensory impairment •Hearing •Cognitive assessment tools to account for sensory impairment •Vision •Knowledge gaps and research opportunities 11/14/2017 3

  4. Sensory Impairment in the Memory Clinic •Accuracy of testing •Difficulty in communicating with the patient •Patient in the periphery of discussion 11/14/2017 4

  5. Clinic Setting Finger Rub Test Tuning Fork Test Whispered voice test, ticking watch test 11/14/2017 5

  6. Clinic Setting Finger Rub Test Tuning Fork Test Rinne Test Sensitivity 60-90%, specificity 95-98% Sensitivity 98%, Specificity 75% McGee Evidenced-Based Physical Diagnosis 2017 11/14/2017 6

  7. Research Setting •No instructions regarding assessment of sensory impairment prior to testing •No specific cognitive tool to account for sensory impairment 11/14/2017 7

  8. New Screening Tool 11/14/2017 8

  9. New Screening Tool Not consistently reliable for self administration in patients with MMSE < 26 Administration time 5-20 minutes 11/14/2017 9 Pletnikova et al, manuscript in preparation

  10. Barriers to Screening for Sensory Impairment • The U.S. Preventive Services Task Force (2011) (hearing) 2016 (vision) • Insufficient evidence for screening • Memory Clinic • New patient: Nursing time – 45 minutes; Physician time – 45 minutes • Follow up patient: Nursing time – 30 minutes; Physician time – 30 minutes • Much of the nursing time spent on taking history, medication reconciliation, cognitive testing, counseling, documenting on the computer 11/14/2017 10

  11. New Cognitive Assessment Tools • Killen et al. Age Ageing 2013 • Individuals with vision impairment performed poorly on vision dependent items on Mini Mental Status Exam (MMSE) and Clock Drawing Test • Vision independent (VI) items on MMSE and Clock Test for the visually impaired 11/14/2017 11

  12. Knowledge Gaps and Research Opportunities • Lack of knowledge about test characteristics of screening tools in patients with cognitive impairment • Further understanding of sensitivity, specificity, etc. of widely used clinical tools in individuals with cognitive impairment (ex. ipad based portable audiometer) • Lack of understanding about important clinical outcomes related to sensory impairment in individuals with cognitive impairment • Further research about what patients with cognitive impairment and their caregivers value as important clinical outcomes • Conducting larger, good quality studies of screening and treating sensory impairment with the above outcomes • Lack of knowledge about cognitive assessment tools that account for sensory impairment in clinic and research settings • Determining ideal, standardized assessment tools for dissemination