Assessing Cognition in Parkinson’s Clinic
Cognitive impairment in Parkinson’s disease is common and associated with significant morbidity and mortality. However, when and how patients are diagnosed with cognitive impairment is often very variable. This diagnostic difficulty has been recognised by the Parkinson’s UK Evidence- Based Practice working group. As such they have proposed an algorithm to offer guidance on how to carefully consider a possible diagnosis of mild cognitive impairment. This algorithm recommended the use of the Parkinson’s Disease- Cognitive Functional Rating Scale (PD-CFRS) in certain circumstances.
This project aimed to evaluate the current practice of the assessing patient’s cognition and then introduce the PD-CFRS. The aim was to then compare data to see if there any been any change in the diagnosis of either mild cognitive impairment or Parkinson’s disease dementia with the implementation of this scale. Unfortunately, because of staffing pressures related to the pandemic the outpatient clinic where this project was taking place was shut because of a lack of available nursing staff so it has not been possible to complete the full evaluation as planned.
This project look place in an older people day unit where outpatients Parkinson’s clinics are held. The format of this clinic is that nursing staff from the unit call patients in advance of the clinic to screen for certain symptoms as well as asking them to highlight the main issues they want to raise at their medical appointment. As part of this screening the patient will be asked if they have any concerns about their memory. If they are then seen face to face a MOCA will be completed if concerns have been raised.
This project reviewed 4 months of appointments. Inclusion criteria included a diagnosis of idiopathic Parkinson’s disease and the appointment had to be face to face. Patients were not included if they already had a diagnosis of cognitive impairment or dementia.
In total 35 patients were eligible over this 4-month period. Of these 35 patients 31 were asked on the telephone if they had any concerns about their memory and 12 described concerns. When seen face to face 9/35 described concerns regarding their memory. 3 patients were given a diagnosis of cognitive impairment and one other patient had a change in their medications on account of describing cognitive difficulties. 30 of the 35 patients had had a MOCA in the last 12 months and the mean score was 24.
The conclusion from this was that the current clinic set up appears to work well in asking and identifying concerns about cognition and also formally assessing cognition using a MOCA. However it is less good at taking action on those concerns and making a formal diagnosis. Unfortunately as stated above I have been unable to gain sufficient data of how practice has changed with the use of the PD-CFRS. We have been able to trial use in clinic and found it is simple to perform and asking questioning takes less than 5 minutes however some members of the team found the scoring system confusing and so we intend to clarify instructions before using it with the rest of the team. Provided circumstances do not change further we hope to have further results within the next 3 months.
More Parkinson's Academy Cognition Projects
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Parkinson's Academy, our original and longest running Academy, houses 19 years of inspirational projects, resources, and evidence for improving outcomes for people with Parkinson's. Led by co-founder and educational director Dr Peter Fletcher, the Academy has a truly collegiate feel and prides itself on delivering 'the things you can't get from books' - a practical learning model which inspires all Neurology Academy courses.