Screening for Cognitive Impairment in the Emergency Department: Agreement between Older Adult Patient- and Informant-Completed Ascertain Dementia 8 Tool

Introduction: Emergency department (ED) screening for cognitive impairment (CI) is crucial for early intervention, yet guidance on dementia screening protocols remains limited. Our objective was to assess the concordance between the Ascertain Dementia 8 (AD8) tool, a brief screening tool for CI, administered to ED patients and their informants. Methods: We conducted a prospective observational study of dyads, including patients ≥65 years without a diagnosis of dementia seeking care in the ED and their informants (e.g., family, friend with close contact). Trained research assistants used the 4AT to exclude patients with concern for delirium. The AD8 was then administered to blinded patients (pAD8) and informants (iAD8), with scores ranging from 0 to 8 and scores of ≥2 indicating CI. We used the intraclass correlation coefficient (ICC) to calculate the level of agreement between AD8 scores. Results: Our analytic sample included 538 dyads, of which 63.3% of patients were female with a mean age of 73.5 years. A total of 131 (24.3%) patients without a diagnosis of dementia self-identified as having CI using the pAD8, in comparison to 110 (20.4%) informants using the iAD8. The ICC of 0.519 (95% CI 0.454–0.578) indicated moderate agreement between pAD8 and iAD8 scores. Conclusions: When seeking emergency care, one in four older adults without a diagnosis of dementia and approximately 20% of informants indicated that patients were cognitively impaired. Our finding of moderate agreement between the pAD8 and iAD8 has important implications for clinicians providing care to patients with suspected CI and investigators conducting dementia-related studies.

Older adults frequently visit the emergency department (ED) for urgent medical care, but can often have underlying cognitive impairment (CI) that goes unnoticed. CI can affect an older adult’s ability to understand and follow medical advice in the ED, and therefore, detecting CI is crucial to providing appropriate care for these patients. The Ascertain Dementia 8 (AD8) is a quick screening tool typically administered to an informant, such as a patient’s family member, friend, or caregiver. However, no prior studies have compared the AD8 responses between patients and their informants. Exploring the agreement of AD8 scores between patients and informants may offer the opportunity to directly administer the AD8 to patients, allowing for cognitive screening in the ED to be more feasible. This study examined whether AD8 scores provided by older adults matched those given by their informants in the ED. Patients with a prior history of dementia and those without an available informant were excluded. The study consisted of 538 pairs of patients and informants. The findings showed that 24.3% of patients identified themselves as having CI, while 20.4% of informants identified patients as having CI. There was moderate agreement between the patient-completed and informant-completed AD8 scores.