Optimizing Dementia Screening: Best Practice Guidelines for Neurocognitive Concerns in Older Adults
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Authors
Borchardt, Gail
Issue Date
0025-12-12
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Type
Manuscript
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Keywords
cognitive impairment , neurocognitive , geriatric , older adult , dementia screening , cognitive evaluation
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Abstract
Abstract
A DNP student QI project appraised brief cognitive screening tools to improve the screening process in a Transitional care setting, aimed to optimize dementia recognition. Thirty-three participants were screened using 3 brief tools over an 11-week period. The implementation of consistent evidence-based, brief cognitive screening tools with high validity significantly improved screening that identified cognitive impairment risk and referral opportunity.
Background: Currently more than 55 million people have dementia worldwide (CDC, 2023) with 10 million new cases every year, yet still another 41 million dementia cases go undiagnosed across the globe (Alzheimer’s Disease International, 2021). Although dementia is not a normal part of aging, its gradual progression frequently complicates early detection and diagnosis. Undetected or underdiagnosed dementia carries significant consequences, including reduced patient quality of life, elevated caregiver burden, and increased healthcare system costs (World Health Organization, [WHO], 2025). Early identification is crucial, as it provides opportunities to address reversible causes of cognitive impairment, improve care, and enhance outcomes for individuals affected by dementia. Despite the significance of screening for cognitive impairment, there is no single brief (<10 minute) cognitive assessment tool considered to be the gold standard for use in outpatient clinical settings. A DNP student QI project aimed to pilot and evaluate three evidence-based cognitive screening tools in 100% of patients aged 65 and older upon admission to one Transitional Care Unit (TCU) Quick Dementia Rating System (QDRS), BrainCheck, and TabCAT, to determine feasibility, effectiveness, and patient engagement.
Methods: Over an 11-week period, 33 patients aged 65 and older admitted to one TCU were screened using QDRS, BrainCheck, and TabCAT. Completion time, convergent validity, patient preference, and subjective feedback were analyzed using descriptive statistics and Pearson correlation.
Results: All tools require less than 10 minutes to administer, with QDRS being the fastest (mean = 3.36 min). BrainCheck and TabCAT exhibited strong correlations (r = –0.76, p < 0.001), suggesting aligned diagnostic intent. BrainCheck flagged 64% of patients for further evaluation and was most preferred by participants (71%). TabCAT, while more complex and time-intensive (mean = 10.18 min), provided detailed cognitive profiling. All three tools accurately identified previously diagnosed dementia cases. Subjective feedback highlighted BrainCheck's approachability, while some found TabCAT overwhelming due to image sequencing and face-association tasks. These findings aligned with the anticipated outcomes of the quality improvement project. After administering and analyzing each tool, final reports were developed and shared. For patients who screened positive, customized follow-up letters with results were offered for their primary care providers to support continuity and further evaluation.
Conclusion: Integrating brief cognitive screening tools into Transitional Outpatient Care increased screening rates and demonstrated clinical feasibility. This project offers insight into how patient-centered tools can support timely recognition in older adults. Evaluating QDRS, BrainCheck, and TabCAT, each under 10 minutes, showed their ability to identify previously unrecognized cognitive impairment. Alignment in diagnostic performance, alongside differences in patient experience, highlights the importance of flexibility and usability in implementation. These findings support scalable, routine cognitive screening in outpatient settings, positioning brief assessments as essential to addressing dementia’s clinical, emotional, and financial impact.
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Creighton University
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Copyright is retained by the Author. A non-exclusive distribution right is granted to Creighton University