A Comparison of Measures for Identifying Possible Dementia in Veterans Affairs Nursing Home Residents.
Joshua D Niznik, Florentia E Sileanu, Xinhua Zhao and 9 others
PMID 39890090WHAT IT FOUND
Diagnosis codes and nursing home cognitive assessment scales found different groups of Veterans with possible dementia.
The cognitive scale found more people, while diagnosis-based measures found fewer but were less likely to label residents without cognitive impairment.
Key findings
01Among 54,237 eligible admissions, the MDS Cognitive Function Scale found any cognitive impairment in 50.8%, the CCW claims algorithm found dementia in 38.6%, and MDS active dementia indicators found dementia in 23.3%.
02Using the Cognitive Function Scale as the reference, CCW dementia diagnosis codes identified 56.5% of residents with any cognitive impairment, and MDS active dementia indicators identified 38.1%.
03Among 33,298 Veterans meeting at least one dementia or cognitive impairment criterion, 29.4% met all three criteria, and the Cognitive Function Scale alone identified 33.8%.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study compared existing records, not clinical dementia diagnoses. The reference standard was the MDS Cognitive Function Scale, so the results show how well diagnosis-based measures match routine cognitive assessment, not how well they confirm dementia. It was cross-sectional at admission, so it did not follow residents over time or check whether measures changed after admission, including during the pandemic. The sample required age 65 or older, VA and Medicare Parts A and B enrollment for the prior two years, and complete MDS cognitive data, so it may not represent Veterans admitted to VA nursing homes without those records. The MDS active condition indicators depend on diagnoses being active in the last seven days and relevant to the care plan, and claims-based codes depend on documentation in VA or Medicare records; poor documentation can reduce detection. The study did not test whether using one measure instead of another changes patient care or outcomes.
Declared interests
The authors reported no conflicts of interest, and funding sources had no role in the study design, data collection and analysis, manuscript preparation, or submission.
The easy way to misread this
Do not treat the MDS Cognitive Function Scale as a confirmed dementia diagnosis or as proof that one measure is best. The study compared routine records and found that the Cognitive Function Scale identified more residents with possible cognitive impairment, while diagnosis-based measures were more specific but identified fewer residents with cognitive impairment; no clinical dementia evaluation was used as the reference.