Improving Early Recognition of Alzheimer's Disease: A Review of Telephonic Screening Tools

As the elderly population in the United States has grown, there has been a commensurate increase in the incidence and prevalence of Alzheimer’s disease (AD). The U.S. General Accounting Office estimates that 1.9 million Americans aged 65 years and older have some form of AD, with 1.1 million having moderate or severe AD [1]. Unfortunately, Alzheimer’s disease frequently remains unrecognized or undiagnosed, particularly in its early stages. Although individuals with this condition may receive medical care regularly, physicians and other health care providers often fail to identify patients with dementia, even when the symptoms are quite pronounced [2‐4]. In addition, even close family members often fail to recognize the signs of dementia. Developing and implementing a valid and efficient casefinding methodology for use in today’s busy and costconscious primary care setting is an important first step in identifying and treating early-stage AD in a greater number of patients. For Medicare managed care organizations (MCOs) required to do a general health screen of all new members, a telephone screening instrument for dementia represents such a methodology. Telephonic assessment of elderly persons is reliable and valid in a range of domains, including activities of daily living [5], quality of life [6], and depression [7]. In a comparison of face-to-face and telephone versions of several cognitive assessments, Carpenter and colleagues found that for healthy elderly persons, assessing memory via telephone (at least for verbal memory) can be an efficient means of evaluating individuals [8]. To be useful in today’s cost-conscious medical environments, whether in a managed care or large group practice setting, a telephonic screening tool needs to possess several attributes. The tool must be easy to administer and structured so that a nonclinical interviewer can administer it; it must be able to be administered regardless of caregiver availability; and it should be short, taking no more than 3 to 5 minutes to administer. This length would allow the tool to be added to existing regularly conducted health status questionnaires, thus minimizing overall administrative burden. This article will review current AD telephone screening tools and assess their overall usefulness in a managed care or group practice setting.