Clionsky Neuro Systems, USA
Title: Brief evaluation of cognitive impairment using The Memory Orientation Screening Test
Emily Clionsky, M.D graduated from Jefferson Medical College, is dually trained in internal medicine (Mercy Hospital/UPMC Pittsburgh, PA) and in psychiatry (Dartmouth Hitchcock Medical Center). Her practice is dementia- focused, with over 3,000 patients. She has presented research on hypoxia and dementia at AAIC in 2012, has published in peer-reviewed journals, and with Mitchell Clionsky, Ph.D., co-developed the Memory Orientation Screening Test//MOST-96120. Dr. Emily Clionsky is the Director of Clinical Strategies for Lincare, Inc. a subsidiary of Linde AG. She is the co-editor in chief of the Journal of Alzheimer’s Disease and Parkinsonism. Mitchell Clionsky, Ph.D. ABPP(CN) is a board certified clinical neuropsychologist with more than 30 years experience in hospital and outpatient settings. He directs a multi-specialist outpatient practice in Springfield, MA that specializes in the evaluation and management of dementia, traumatic brain injury, attention deficit problems, and other neurologically-related illnesses. Integration of clinical care and research is a primary focus of this practice. He and his wife/partner, Emily Clionsky, M.D, are the developers of the Memory Orientation Screening Test®, a 5-minute neuropsychologically-based test for primary care physicians and specialists to use in identifying dementia and tracking its level over time. In addition, Dr. Clionsky developed tests for patient- and informant-awareness of cognitive impairment, a measure of patient ability to learn and recall practical list information, and a test of logical reasoning.
Within this aging population over the age of 65, one-third of patients demonstrate either Mild Cognitive Impairment or Dementia. Cognitively impaired patients suffer from a degenerative condition that impairs function and leads to institutionalization and death. Cognitively impaired patients do not reliably follow treatment for other medical conditions such as hypertension and diabetes. They are at higher risk for falls, post-operative delirium from elective surgeries, and readmissions to acute care hospital settings. They require care from family and paid caregivers that are expensive and difficult to deliver without interrupting the family unit. They lose independence, cause auto accidents, and are victims of financial scams. Unfortunately, the majority of patients with MCI or Dementia are not diagnosed until symptoms have been present for years and until glaring examples of their difficulties are seen. These patients deny or minimize their problems. Their family members may not observe the losses accurately or recognize the symptoms of cognitive loss. Their doctors and health care providers lack the time and information necessary to make the diagnosis. Earlier detection of dementia increases opportunities for earlier medical and social interventions. Clinicians who employ a brief, sensitive and reliable test of cognition will detect cognitive loss sooner and will possess objective data on which to base more costly emerging diagnostic tests and therapeutic interventions. They will then be able to more accurately assess changes in cognitive status over time, helping them to make changes in treatment approach and to counsel patients and families about the patient’s needs. Furthermore, accurate test scores allow the provider to reassure the intact but worried elderly patient and to avoid ordering costly and unnecessary tests. Over the past three years, three validation studies involving the Memory Orientation Screening Test (MOST) has been published, demonstrating its high concordance with expert clinical diagnosis and with standardized neuropsychological tests. It has shown higher accuracy and reliability, in these studies, when compared to the MMSE, Mini-Cog, Clock Drawing Test, family reports, and patient self-ratings. The MOST is also now available on two iPad apps, improving ease of administration, accuracy in scoring, and generating a detailed clinical report for each use. The report translates the results of this 5-minute test into a statement cognitive function and generates a series of recommendations for further testing, treatment options, and practical patient care decisions that guide the provider to make scientifically-based treatment plans.