Diagnosing mild cognitive impairment in Parkinson’s disease

A quality improvement project conducted as part of the Dementia Academy 'Mild cognitive impairment virtual course' which ran from March-September 2021.

Background

Mild cognitive impairment (MCI) is a common feature in Parkinson’s disease (PD), even at the time of diagnosis (Yarnall, 2013), and increases risk to future conversion to Parkinson’s disease dementia (PDD). To prevent unnecessary cognitive deterioration, maximise quality of interventions and support to people with Parkinson's, it is important to monitor for MCI in those with the condition (Cammisuli, 2019)

Clinical Deficit

There are currently no formal processes of monitoring patients with Parkinson's for MCI within local Parkinson's clinics. The Parkinson’s Excellence Network supports the use of a PD-MCI algorithm which includes the PD-Cognitive Function Rating Scale (PD-CFRS) for use within routine Parkinson's Clinics, although this is yet to be widely implemented. This is to ensure people with Parkinson's are fully assessed and appropriately supported if they experience cognitive decline.

Aims of intervention

To determine whether:

1. the PD-MCI algorithm is feasible for use in routine Parkinson's clinics

2. use of this algorithm can improve detection of Pd-MCI including whether it leads to a change in service management or patient diagnosis.

This snapshot refers to part one of the 2 aims.

Methodology

• Exclusion was made for patients with anything other than idiopathic Parkinson's, and those already diagnosed with dementia.

• 3 month's data was reviewed in Parkinson’s clinic, also noting age, gender, disease duration (to nearest year), and most recent cognitive score

• Informal training for nurses and implementation of the PD-CFRS ), monitoring and reviewing the implementation through:

  • percentage of eligible patients with PD-CFRS applied

  • time taken to complete scale

  • completion of global cognitive testing

  • proportion diagnosed after 2 months of implementation (PD-MCI possible if PD-CFRS score >2, PDD>6) and associated cognitive score (where this was also taken)

  • Of those diagnosed, was further action taken and what.

Outcomes

4 patients had their management plan adjusted with 3 medication changes and 1 referral to a memory clinic.

Results suggest positive measures in asking about an assessing cognition using the MoCA but that this does not follow up with reviews or formal documentation.

Training on the PD-MCI algorithm has now been implemented with the nursing team with a view to completing part 2 of the project aim when the service will be reassessed.

Post-project update (Nov 2021):

Given the above conclusions, the team has continued to perform the PD-CFRS in patients who have expressed concerns regarding their cognition, which has been across very small numbers of patients to date. However, early observations are:

• It is suited to the current set up within the day hospital

• It is not too time consuming, taking less than 5 minutes.

• There have been difficulties in calculating the scores and so the plan is to clarify scoring instructions but no other concerns have been identified.

The team intends to continue using the PD-CFRS and re-evaluate the outcome of cognitive assessments again in Spring 2022.