OVERVIEW: PHYSICIAN REPORTS

Screen’s Physician Reports contain:

• The patient’s testing scores in each of the three cognitive domains (memory, symbol fluency, executive function) with both cross-sectional and longitudinal analyses;
• An overall assessment of the likelihood that the patient would be classified as having MCI if the patient were given a full neuropsychological exam;
• Other background information: the patient’s self-reported head injuries, level of depression, alcohol use, current pain medication usage, past expose to solvents, and exercise.

 

SCREEN PHYSICIAN REPORTS: AN EXAMPLE

In order to present the test data in relevant categories (normal, caution, impairment), the patient’s test data are first standardized. Z-scores record the patient’s “distance from average” comparing the results to those of hundreds of other people who took the CANS-MCI. That distance (the standard deviations) captures the likelihood that the patient's ability deviates from the average (for people with a similar educational level).

Screen uses bands of colors to present the patient's test scores and the probability of MCI more intuitively. In the cognitive test tables, standardized z-scores which lie in the green bands represent a high likelihood that the patient's memory health is normal (for their education). Z-scores that fall in the yellow bands (caution) suggest a lower likelihood that the patient's test scores are normal. And those that lie in the red bands have low probability that their memory health is normal. Z-scores in the red bands show a high probability of cognitive impairment.

You can open an example of our 2-page report in PDF format. This report is on a woman whose husband became very ill between the first and second testing sessions and died before the third session. One can see that the woman first got worse and then began to recover. (A briefer, less detailed 1-page report is also available to providers upon request). Below is an example of the way we depict changes over time for 3 cognitive factors and for the overall probability of MCI.

 

Memory Performance

Table 1. Memory Performance

98th    –    top
84th    –    97th
51st    –    83th	0.18
41st    –    50th
31st    –    40th		-0.33
17th    –    30th
8th    –    16th			-1.13
3rd    –    7th
1st    –    2nd
Bottom 1%
DATE	12/6/07	12/14/08	11/20/09

 

 

Symbol Fluency

Table 2. Symbol Fluency

98th    –    top
84th    –    97th
51st    –    83th		0.29
41st    –    50th	-0.05
31st    –    40th			-0.32
17th    –    30th
8th    –    16th
3rd    –    7th
1st    –    2nd
Bottom 1%
DATE	12/6/07	12/14/08	11/20/09

 

 

Executive Function

Table 3. Executive Function

98th    –    top
84th    –    97th
51st    –    83th	0.08
41st    –    50th		-0.14
31st    –    40th
17th    –    30th			-0.84
8th    –    16th
3rd    –    7th
1st    –    2nd
Bottom 1%
DATE	12/6/07	12/14/08	11/20/09

 

 

Probability Of MCI

Table 4: Probability of MCI

< 10%
10 - 19%	X
20 - 29%
30 - 39%		X
40 - 49%
50 - 59%
60 - 69%			X
70 - 79%
80 - 89%
90 - 100%
DATE	12/6/07	12/14/08	11/20/09

 

As seen in this example, Screen’s Report not only presents the test data in easily-understood Tables (so the doctor can be visually alerted to the trends). The report also estimates the probability of MCI (based upon algorithms involving independent full neuropsychological evaluations, age- and education-specific normative data, and the person’s own longitudinal performance). A live tester evaluates each testing session in the context of risk factors, the level of depression, and the pattern of factor scores.

 

OTHER FACTORS

Below is an example of a report section concerning contributing factors which might be worthy of doctor attention before the next testing session.

• Depression can cause or be confused with cognitive impairments or subjective memory deficits. This person answered 7 of the 10 depression scale questions in the symptomatic direction, indicating a need for close attention to depression. He is currently taking an antidepressant.
• These test results must be interpreted in the context of a possible alcohol problem, since she reports drinking every day in the last month.
• He reports 6-10 years of occupational or other major exposure to solvents, a factor known to increase the risk of cognitive impairment.
• He has a history of head injury, a suspected risk factor, reporting 3 lifetime head injuries resulting in unconsciousness.
• He may be deriving a preventive effect from 16-20 years of regular exercise.

 

USE OF REPORTS

For some patients, Screen’s Report might show that everything looks OK. For others, the doctor might decide that the low test results should be followed up with a patient meeting, additional testing, or specialty referrals. Sometimes a specific contributing factor such as depression or alcohol use needs to be addressed before a repeat testing. In all of these situations, Screen’s Physician Reports were constructed so the doctor could show their patient and their families the graphs and information in the report, and patients with their families could better understand the next steps.