Detecting Cognitive Impairment and Dementia in the Emergency Department: A Scoping Review

doi:10.1016/j.jamda.2022.03.019

. 2022 Aug;23(8):1314.e31-1314.e88.

doi: 10.1016/j.jamda.2022.03.019.

Detecting Cognitive Impairment and Dementia in the Emergency Department: A Scoping Review

Collaborators, Affiliations

Collaborators

GEAR 2.0-ADC Network:
Neelum Aggarwal, M Fernanda Bellolio, Marian Emmy Betz, Kevin Biese, Cynthia Brandt, Stacey Bruursema, Ryan Carnahan, Christopher R Carpenter, David Carr, Jennie Chin-Hansen, Morgan Daven, Nida Degesys, Scott M Dresden, Michael Ellenbogen, Jason Falvey, Beverly Foster, Cameron Gettel, Andrea Gilmore-Bykovskyi, Elizabeth Goldberg, Jin Han, James Hardy, S Nicole Hastings, Teresita Hogan, Eric Isaacs, Naveena Jaspal, Jerry Johnson, Kathleen Kelly, Maura Kennedy, Amy Kind, Michael Malone, Monica Moreno, Nancy Morrow-Howell, Brenda Oiyemhonlan, Jason Resendez, Kristin L Rising, Bob Savage, Joe Suyama, Jeremy Swartzberg, Vaishal Tolia, Allan Vann, Teresa Webb, Sandra Weintraub

Affiliations

¹ Department of Emergency Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA; Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, USA.
² Department of Emergency Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA.
³ Department of Psychiatry, University of California, San Diego, San Diego, CA, USA.
⁴ Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Research and Development, James J. Peters VAMC, Bronx, NY, USA.
⁵ Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁶ Dementia Action Alliance, Charlottesville, VA, USA.
⁷ Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, USA.
⁸ Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
⁹ Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Geriatric Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, NY, USA.
¹⁰ Senior ER, St Mary Mercy Hospital, Livonia, MI, USA.
¹¹ Division of General Medicine and Geriatrics, Department of Medicine, Emory School of Medicine, Atlanta, GA, USA.
¹² Berbee Walsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA; Department of Medicine (Geriatrics and Gerontology), University of Wisconsin-Madison, Madison, WI, USA; Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA.
¹³ Department of Emergency Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA; Geriatric Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, NY, USA. Electronic address: ula.hwang@yale.edu.

PMID: 35940682
PMCID: PMC10804640
DOI: 10.1016/j.jamda.2022.03.019

Detecting Cognitive Impairment and Dementia in the Emergency Department: A Scoping Review

Armin Nowroozpoor et al. J Am Med Dir Assoc. 2022 Aug.

. 2022 Aug;23(8):1314.e31-1314.e88.

doi: 10.1016/j.jamda.2022.03.019.

Authors

Collaborators

GEAR 2.0-ADC Network:
Neelum Aggarwal, M Fernanda Bellolio, Marian Emmy Betz, Kevin Biese, Cynthia Brandt, Stacey Bruursema, Ryan Carnahan, Christopher R Carpenter, David Carr, Jennie Chin-Hansen, Morgan Daven, Nida Degesys, Scott M Dresden, Michael Ellenbogen, Jason Falvey, Beverly Foster, Cameron Gettel, Andrea Gilmore-Bykovskyi, Elizabeth Goldberg, Jin Han, James Hardy, S Nicole Hastings, Teresita Hogan, Eric Isaacs, Naveena Jaspal, Jerry Johnson, Kathleen Kelly, Maura Kennedy, Amy Kind, Michael Malone, Monica Moreno, Nancy Morrow-Howell, Brenda Oiyemhonlan, Jason Resendez, Kristin L Rising, Bob Savage, Joe Suyama, Jeremy Swartzberg, Vaishal Tolia, Allan Vann, Teresa Webb, Sandra Weintraub

Affiliations

¹ Department of Emergency Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA; Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, USA.
² Department of Emergency Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA.
³ Department of Psychiatry, University of California, San Diego, San Diego, CA, USA.
⁴ Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Research and Development, James J. Peters VAMC, Bronx, NY, USA.
⁵ Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁶ Dementia Action Alliance, Charlottesville, VA, USA.
⁷ Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, USA.
⁸ Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
⁹ Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Geriatric Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, NY, USA.
¹⁰ Senior ER, St Mary Mercy Hospital, Livonia, MI, USA.
¹¹ Division of General Medicine and Geriatrics, Department of Medicine, Emory School of Medicine, Atlanta, GA, USA.
¹² Berbee Walsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA; Department of Medicine (Geriatrics and Gerontology), University of Wisconsin-Madison, Madison, WI, USA; Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA.
¹³ Department of Emergency Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA; Geriatric Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, NY, USA. Electronic address: ula.hwang@yale.edu.

PMID: 35940682
PMCID: PMC10804640
DOI: 10.1016/j.jamda.2022.03.019

Abstract

Objectives: To identify research and practice gaps to establish future research priorities to advance the detection of cognitive impairment and dementia in the emergency department (ED).

Design: Literature review and consensus-based rankings by a transdisciplinary, stakeholder task force of experts, persons living with dementia, and care partners.

Setting and participants: Scoping reviews focused on adult ED patients.

Methods: Two systematic scoping reviews of 7 medical research databases focusing on best tools and approaches for detecting cognitive impairment and dementia in the ED in terms of (1) most accurate and (2) most pragmatic to implement. The results were screened, reviewed, and abstracted for relevant information and presented at the stakeholder consensus conference for discussion and ranked prioritization.

Results: We identified a total of 1464 publications and included 45 to review for accurate tools and approaches for detecting cognitive impairment and dementia. Twenty-seven different assessments and instruments have been studied in the ED setting to evaluate cognitive impairment and dementia, with many focusing on sensitivity and specificity of instruments to screen for cognitive impairment. For pragmatic tools, we identified a total of 2166 publications and included 66 in the review. Most extensively studied tools included the Ottawa 3DY and Six-Item Screener (SIS). The SIS was the shortest to administer (1 minute). Instruments with the highest negative predictive value were the SIS (vs MMSE) and the 4 A's Test (vs expert diagnosis). The GEAR 2.0 Advancing Dementia Care Consensus conference ranked research priorities that included the need for more approaches to recognize more effectively and efficiently persons who may be at risk for cognitive impairment and dementia, while balancing the importance of equitable screening, purpose, and consequences of differentiating various forms of cognitive impairment.

Conclusions and implications: The scoping review and consensus process identified gaps in clinical care that should be prioritized for research efforts to detect cognitive impairment and dementia in the ED setting. These gaps will be addressed as future GEAR 2.0 research funding priorities.

Keywords: Dementia; cognitive impairment; emergency department.

Published by Elsevier Inc.

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Conflict of interest statement

The authors declare no conflicts of interest.

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The Geriatric Emergency Care Applied Research Standardization Study (GEARSS): An Observational Study of Older Emergency Department Patients.
Hwang U, Sifnugel N, Cohen I, Han L, Araujo K, Bianco LM, Brandt CA, Capelli S, Carpenter CR, Cruz DS, Dresden SM, Fishman IL, Gipson K, Hastings SN, Hung WW, Kang R, Lockhart M, Meeker D, Ohuabunwa U, Ottilie-Kovelman S, Partridge C, Platts-Mills TF, Sandoval J, Taylor Z, Tomasino DF, Vaughan CP. Hwang U, et al. Acad Emerg Med. 2025 Jul 12:10.1111/acem.70101. doi: 10.1111/acem.70101. Online ahead of print. Acad Emerg Med. 2025. PMID: 40650481
Detection and differentiation of undiagnosed dementia in the emergency department: A pilot referral pathway.
Gettel C, Galske J, Araujo K, Dresden S, Dussetschleger J, Iannone L, Lai J, Martin P, Mignosa B, Muschong K, Safdar B, Weintraub S, Hwang U. Gettel C, et al. Alzheimers Dement. 2025 Apr;21(4):e70189. doi: 10.1002/alz.70189. Alzheimers Dement. 2025. PMID: 40257011 Free PMC article.
Moving beyond tokenism: Sustaining engagement of persons living with dementia in identifying emergency research priorities.
Sandoval J, Gilmore-Bykovskyi A, Carpenter CR, Shah MN, Dussetschleger J, Dresden S, Ellenbogen M, Gil H, Jaspal N, Jobe D, Vann A, Webb T, Hwang U. Sandoval J, et al. J Am Geriatr Soc. 2025 May;73(5):1344-1352. doi: 10.1111/jgs.19269. Epub 2024 Nov 22. J Am Geriatr Soc. 2025. PMID: 39576051
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Taylor RA, Gilson A, Chi L, Haimovich AD, Crawford A, Brandt C, Magidson P, Lai JM, Levin S, Mecca AP, Hwang U. Taylor RA, et al. Sci Rep. 2023 Dec 18;13(1):22618. doi: 10.1038/s41598-023-49330-8. Sci Rep. 2023. PMID: 38114545 Free PMC article.

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References

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[1] Zhao Y, Kuo TC, Weir S, KRamer MS, Ash AS. Healthcare costs and utilization for Medicare beneficiaries with Alzheimer’s. BMC Health Serv Res. 2008;8:108. - PMC - PubMed

[2] Zhao Y, Kuo TC, Weir S, KRamer MS, Ash AS. Healthcare costs and utilization for Medicare beneficiaries with Alzheimer’s. BMC Health Serv Res. 2008;8:108. - PMC - PubMed

[3] Feng Z, Coots LA, Kanganova Y, Wiener JM. Hospital and ED use among Medicare beneficiaries with dementia varies by setting and proximity to death. Health Aff (Millwood). 2014;33:683–690. - PubMed

[4] Feng Z, Coots LA, Kanganova Y, Wiener JM. Hospital and ED use among Medicare beneficiaries with dementia varies by setting and proximity to death. Health Aff (Millwood). 2014;33:683–690. - PubMed

[5] Carpenter CR, DesPain B, Keeling TN, Shah M, Rothenberger M. The Six-Item Screener and AD8 for the detection of cognitive impairment in geriatric emergency department patients. Ann Emerg Med. 2011;57:653–661. - PMC - PubMed

[6] Carpenter CR, DesPain B, Keeling TN, Shah M, Rothenberger M. The Six-Item Screener and AD8 for the detection of cognitive impairment in geriatric emergency department patients. Ann Emerg Med. 2011;57:653–661. - PMC - PubMed

[7] Carpenter CR, Griffey RT, Stark S, Coopersmith CM, Gage BF. Physician and nurse acceptance of geriatric technicians to screen for geriatric syndromes in the emergency department. West J Emerg Med. 2011;12:489–495. - PMC - PubMed

[8] Carpenter CR, Griffey RT, Stark S, Coopersmith CM, Gage BF. Physician and nurse acceptance of geriatric technicians to screen for geriatric syndromes in the emergency department. West J Emerg Med. 2011;12:489–495. - PMC - PubMed

[9] Kent T, Lesser A, Israni J, Hwang U, Carpenter C, Ko K. 30-Day emergency department revisit rates among older adults with documented dementia. J Am Geriatr Soc. 2019;67:2254–2259. - PMC - PubMed

[10] Kent T, Lesser A, Israni J, Hwang U, Carpenter C, Ko K. 30-Day emergency department revisit rates among older adults with documented dementia. J Am Geriatr Soc. 2019;67:2254–2259. - PMC - PubMed

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Detecting Cognitive Impairment and Dementia in the Emergency Department: A Scoping Review

Collaborators

Affiliations

Detecting Cognitive Impairment and Dementia in the Emergency Department: A Scoping Review

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Similar articles

Cited by

References

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MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Abstract

Conflict of interest statement

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Cited by

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