First Choice Neurology

Medicare Sees a Growing Demand for Cognitive Assessment with Patients Suffering from Memory Disorders

Dr. Jeff Gelblum, a board-certified Neurologist with First Choice Neurology, makes great use of the cognitive assessment in his daily practice.

Gelblum states, “this activity enables me to determine the specific daily impact of dementia on my patients and allows me to implement a meaningful treatment plan. This plan can include medication as well as arranging for home health care, referral to community support groups, or something as simple as implementing Uber access to avoid the risk of driving.”

Gelblum further observes that “the cognitive assessment is an important tool to determine whether a patient would be a candidate for the new FDA-approved drug for Alzheimer’s disease, Aduhelm.”

What is Aduhelm?

Alzheimer’s patients and their families are excited about Biogen’s Aduhelm (Aducanumab), a promising infusion treatment for Alzheimer’s disease.

Aduhelm is the first new treatment approved for Alzheimer’s since 2003 and is the first therapy that targets the fundamental pathophysiology of the disease.

Researchers evaluated Aduhelm’s efficacy in three separate studies. Patients receiving the treatment had a significant reduction of amyloid-beta plaque, while patients in the control arm of the studies had no reduction of amyloid-beta plaque.

These results support the accelerated approval of Aduhelm, which is based on the surrogate endpoint of reduction of amyloid-beta plaque in the brain—a hallmark of Alzheimer’s disease.

What is a Cognitive Impairment Assessment?

Cognitive Impairment Assessment is a special visit covered by Medicare and all insurance plans to specifically assess the overall functionality of a mentally impaired patient.

Prior to the encounter, three intake forms will be completed by the patient and caregiver to assess:
1) activities of daily living, 2) depression, and 3) clinical dementia rating.

During the visit, the patient will complete a mini-mental status exam and undergo a neurologic exam.

This evaluation can be done either in an office or via TeleHealth. The neurologic exam can be conducted once or twice annually. Medicare saw a growing demand for these services and increased coverage in an office setting and telehealth appointments.

What’s Included in a Cognitive Assessment?

• Examine the patient with a focus on observing cognition
• Record and review the patient’s history, reports, and records
• Conduct a functional assessment of Basic and Instrumental Activities of Daily Living, including decision-making capacity
• Use standardized instruments for the staging of dementia-like the Functional Assessment Staging Test (FAST) and Clinical Dementia Rating (CDR)
• Reconcile and review for high-risk medications, if applicable
• Use standardized screening instruments to evaluate for neuropsychiatric and behavioral symptoms, including depression and anxiety
• Conduct a safety evaluation for home and motor vehicle operation
• Identify social supports including how much caregivers know and are willing to provide care
• Address Advance Care Planning and any palliative care needs

What Care Plan Services Result from the Assessment?

Information gathered during a cognitive assessment will help to create a written care plan. The care plan includes initial plans to address:
• Neuropsychiatric symptoms
• Neurocognitive symptoms
• Functional limitations
• Referral to community resources as needed (for example, rehabilitation services, adult day programs, support groups) shared with the patient or caregiver with initial education and support

Findings from the evaluation will facilitate medication, social services, home health aide, STS transport, and other helpful interventions.

Alzheimer's vs. DementiaWhat is Alzheimer’s Disease?

Alzheimer’s is an irreversible, progressive brain disorder that slowly destroys memory and thinking skills, and eventually, the ability to carry out simple tasks. While the specific causes of Alzheimer’s disease are not fully known, it is characterized by changes in the brain—including amyloid plaques and neurofibrillary —that result in the loss of neurons and their connections. These changes affect a person’s ability to remember and think.

There are an estimated 5.7 million people living with Alzheimer’s disease in the United States. 5.5 million people with Alzheimer’s are 65 or older and approximately 200,000 under the age of 65 have younger-onset Alzheimer’s. As the number of Americans grow older, so too will the number of people diagnosed with Alzheimer’s increase.


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