AD8 Dementia Screening Interview

What is the AD8 Dementia Screening Interview?

The AD8 Dementia Screening Interview is a brief informant interview designed to detect cognitive impairment and cognitive ability to help differentiate between normal aging and cognitive decline, including mild cognitive impairment (MCI) and mild dementia. It is used primarily in primary care settings and geriatric emergency department patients, serving as a practical tool to screen for early signs of dementia, particularly Alzheimer's disease. The AD8 is widely utilized due to its ability to detect early cognitive change with high sensitivity and negative predictive value.

Developed by the Knight Alzheimer Disease Research Center of Washington University and evaluated on the Diagnostic and Statistical Manual of Mental Disorders (DSM), the AD8 is a brief informant interview that asks about specific changes in the patient's cognitive abilities, memory, and behavior. The questions cover common signs of dementia, such as problems with memory, attention, judgment, and mood changes, which are key cognitive domains typically affected in Alzheimer's disease and other forms of dementia.

Unlike comprehensive neuropsychological tests, the AD8 dementia screening is designed to be quick and easy, making it suitable for primary care settings and geriatric outpatient clinics. It is especially useful in a primary care setting or during a Medicare annual wellness visit, allowing healthcare providers to screen for dementia time-efficiently.

The AD8 consists of eight simple yes/no questions evaluating cognitive domains compared to baseline measures of function. A higher score indicates greater concern for cognitive decline, leading to a formal neuropsychological evaluation or a clinical assessment using tools like the Mini-Mental State Examination (MMSE) or the Clinical Dementia Rating Scale (CDR) for a more comprehensive diagnosis. This allows clinicians to assess cognitive function and differentiate between normal cognitive aging and more serious cognitive conditions like Alzheimer's disease.

How to use our AD8 Dementia Screening Interview template

To use the AD8 Dementia Screening Interview template:

Step 1: Access the template

Click on "Use template" to open and customize the tool within the Carepatron platform or click "Download" to access a fillable PDF.

Step 2: Conduct the interview

Ask the patient or their informant each of the eight questions, assessing cognitive changes over the past several years. Make sure to inquire about any changes in judgment, memory, hobbies, and daily activities.

Step 3: Mark the responses

For each question, the informant will choose one of the following answers:

• Yes, a change: Indicates a noticeable change in the patient's cognitive abilities (e.g., memory, decision-making).
• No, no change: No noticeable change in cognitive function.
• N/A, don’t know: The informant is unsure or doesn't have enough information to answer the question.

Step 4: Fill in the total score

Add up the number of “Yes, a change” responses across all eight items. This will give you the AD8 score.

Scoring and interpretation

After completing the AD8 interview, interpret the total score according to these cutoff scores (Galvin et al., 2005):

• 0-1: A score in this range indicates normal cognition. While it suggests that a dementing disorder is unlikely, it doesn't completely rule out the possibility of early cognitive decline, especially in cases where other clinical evidence is present.
• 2 or higher: A score of 2 or greater suggests that cognitive impairment is likely present. This indicates the need for further evaluation, including additional diagnostic tests or formal neuropsychological assessment, to confirm the presence and extent of cognitive impairment.

The AD8 is an effective tool for detecting early cognitive changes, but a score above 1 should be followed up with more comprehensive assessments for an accurate diagnosis.

Next steps after using this screening tool

After administering the AD8 dementia screening tool and obtaining a score, the next steps will depend on the results, ensuring that any cognitive impairment or early dementia signs are addressed promptly.

Further evaluation for positive results

Further evaluation is necessary if the AD8 score is 2 or higher, indicating potential cognitive impairment. This could involve:

• Comprehensive geriatric assessment to assess the full extent of cognitive deficits and detect early cognitive decline.
• Conducting additional cognitive tests, such as the Mini-Mental State Examination (MMSE) or more detailed neuropsychological evaluations, to determine the degree of mild cognitive impairment or the presence of mild dementia.
• A clinical assessment to rule out other factors contributing to cognitive changes, as recommended by the Alzheimer’s Association and based on clinical dementia rating scales.

Addressing mild cognitive impairment

In cases of mild cognitive impairment (MCI), clinicians should consider a diagnostic criteria review for conditions like Alzheimer's disease or vascular dementia. MCI may not always progress to dementia, but regular monitoring of cognitive abilities is crucial for detecting further decline.

Referring for specialist evaluation

If the results suggest mild dementia or early signs of more severe cognitive impairment, referral to a specialist, such as a geriatrician or a neurologist, is advised. They may perform more advanced clinical diagnoses.

Follow-up monitoring

For patients in primary care settings, it is essential to schedule follow-up visits to monitor any changes in memory and cognitive function and track any further memory complaints or cognitive decline.

Reference

Galvin, J. E., Roe, C. M., Powlishta, K. K., Coats, M. A., Muich, S. J., Grant, E., Miller, J. P., Storandt, M., & Morris, J. C. (2005). The AD8: a brief informant interview to detect dementia. Neurology, 65(4), 559–564. https://doi.org/10.1212/01.wnl.0000172958.95282.2a