What are neurocognitive disorder screening tests used for?

According to his son, he would be “senile”; for his daughter, he is weak but conscious. At the center of the affair which is tearing Alain Delon's family apart, so-called "cognitive tests" were mentioned which the actor allegedly failed, showing difficulties in discernment. But how are neurocognitive disorders (NCD) detected? Le Figaro takes stock.

Public Health France defines NCDs (including Alzheimer's disease) as the most common neurodegenerative diseases, leading to an increasing loss of cognitive functions and behavioral changes leading to a loss of patient autonomy. If no curative treatment is available, personalized care is possible. There were 1.2 million people affected by TNC in France in 2016 and it is estimated that there will be 1,750,000 in 2030. Detecting TNC using appropriate tests is therefore a challenge given the aging of the population. How do they take place? What do they say about the patient's condition? Are they reliable?

“These tests make it possible to direct the diagnosis towards causes which are not necessarily linked to a neuroprogressive disease, such as memory loss linked to depression or difficulty concentrating linked to alcohol consumption,” explains Professor Marc Verny. , specialist in geriatrics and neurology at the Pitié Salpêtrière hospital (Paris). The interpretation of the tests cannot therefore be done without taking into account various parameters such as the age and socio-educational level of the patient, as well as their medical history. Cognitive tests may be accompanied by other tests to assess the degree of intensity of the disorder (from mild to strong) and the patient's level of dependence. The High Authority for Health (HAS) warns of the fact that “in general medicine, one of the difficulties of the diagnostic approach is to rule out depression in the face of persistent cognitive decline objectively demonstrated by the clinic or by screening tests”. When additional disorders are present, such as psychiatric disorders (depression, bipolarity, schizophrenia), a detailed analysis is offered thanks to interviews with those close to them, and additional examinations such as an MRI or a lumbar puncture allow the detection of specific markers of cognitive diseases.

The significant break with the patient's past functioning and personality is a central element in evoking a possible diagnosis of TNC, according to the HAS. Trying to evaluate this break at different levels (learning, language, decision-making, problem solving, attention, etc.) with tests is not easy. The HAS lists 7 different tests, American, Canadian, Australian, British and French.

The Dubois 5-word test consists of submitting to the patient a list of 5 words that he must associate with a category (flower, clothing, etc.); once the sheet is turned over, he will have to give the words again immediately, then again after a few distracting tests. “The Dubois 5-word test only evaluates memory,” explains Professor Verny. It has the advantage of making it possible to interpret the type of memory disorder to differentiate, for example, a patient suffering from depression from one suffering from early Alzheimer's. But this test does not assess other cognitive sectors such as executive functions” (ability to act in an organized manner to achieve objectives, editor’s note).

The “General Practitioner-Cognition (GP-Cog)” test is the most used in general medicine, because it is short and allows the patient's entourage to be consulted on the severity of symptoms and their temporal evolution. But it is not very specific. Professor Marc Verny indicates that we can also propose the use of several tests to explore several cognitive fields in a reduced examination time.

At the start of the year, the federation of memory centers will propose recommendations for the early diagnosis of TNC, with indications on the tests available and possibly combinations of tests allowing the different fields of cognitive loss to be explored. Some tests match the patient's level to that expected at a certain age, to better analyze the degree of TNC.

In France, unlike other countries, no screening test is recommended in primary care (at the general practitioner). When a patient complains to his doctor about memory loss, cognitive problems, lasting change in behavior or activity, a discussion to collect personal information (medication history, lifestyle, profession, etc.) allows to hypothesize a lasting cognitive decline. The doctor's impression can be compared with standardized tests called “identification tests exploring the cognitive, functional or even behavioral deficit”. The doctor chooses the test that seems most appropriate. However, Professor Marc Verny points to a lack of training for practitioners. “These tests are used too little by general practitioners, but we are seeing a generational effect with young doctors who are more aware of the use of these tests.” The HAS also indicates that TNCs “are sometimes associated with diagnostic wandering and a delay in diagnosis”, despite a rich literature on TNCs and detection methods. Once the disorder is suspected or formally identified, the precise diagnosis of its cause must be made by a hospital or private doctor specializing in TNC with “the support of a certified memory consultation”.

These tests must be taken under standardized conditions, outside any phase of acute pathology. However, it is possible that the patient is not willing to discuss with his doctor when the appointment has been imposed on him by his family. The doctor then takes this element into account. Some of the widely used tests (MMS, MoCA) last 10 to 15 minutes when on average a consultation in general medicine lasts 16 minutes (Dress, 2002) which leaves little time to take the test. Professor Marc Verny indicates that in the near future “advanced practice nurses will be able to take these tests, which is part of their professional skills”. The specialist suggests that a general practitioner collects the cognitive complaint then that the nurse carries out the assessment. The synthesis would be carried out in collaboration between the two health professionals.

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This etiological diagnosis (on the causes of the disorders) makes it possible to optimize the care plan. The doctor then explains the multi-professional, medical and paramedical, medico-social and social care adapted to the patient. The HAS specifies that “the commitment of those close to them and the patient in the care project is necessary, supported and encouraged”.

The HAS specifies that with age “it is common to encounter some difficulties in quickly finding the name of a person, a place, a date; then find them a few minutes later. It is not abnormal to write down everyday things so as not to forget them. Memory loss is worrying from the moment it disrupts the person's daily life or feelings, such as getting lost on a known route, forgetting the name of a loved one or doing "stupid things" like leaving the fire burning in the house. gas stove. The HAS distinguishes major TNCs, when the individual has an impact on their autonomy and becomes incapable of carrying out certain activities of daily life alone (managing their budget, treatments, shopping, etc.) from mild TNCs where the patient preserves the ability to perform activities of daily living alone.