ACCT-AD Full Assessment

The button below goes to a REDCap-based data collection tool to facilitate and document a full diagnostic assessment.

This REDCap tool is intended for educational and clinical decision support only and is not intended to collect or store patient records.
Do not enter patient identifiers or protected health information (PHI), such as names, addresses, birth dates, social security numbers, medical record numbers, or hospital admission or discharge dates.
It is the user's responsibility to comply with applicable privacy laws and institutional policies.

Launch the REDCap full assessment tool

Full Assessment Workflow

Before the visit

Send pre-visit patient questionnaire, provided in the Patient Evaluation Forms, if desired
- Can help identify the symptoms that are raising concerns and the severity, making in-person visit more efficient
- Can be administered as a self-report survey, on paper, online, or delivered in person by clinic staff
Patient and informant complete forms, separately or together (by their choice and convenience)
Provider and/or care team review responses
Consider language and education
- Note Toolkit limitations to decide whether full cognitive evaluation needs to be amended, or pursued through specialty evaluation, vs performed in primary care
- If patient is not fluent in English or has a low level of formal education, make sure you are familiar with the content in the cognitive testing information section.

During the visit

Complete a full assessment
Perform cognitive testing, using the REDCAP form or the PDF form provided in the Patient Evaluation Forms
- Patient and informant attend appointment for accurate history and evaluation
- Go through all questions, even those not endorsed in the pre-visit questionnaire
- Refer to Reference and Interpretation Tables as needed for interpretation of patient/informant responses
Complete education-level-appropriate standardized cognitive test (MoCA, MMSE, 3MS, SLUMS, etc., as desired), using cutoffs and interpretations provided in the Reference and Interpretation Tables
- See the cognitive testing section of the Instruction Manual for links to background information and tutorials on standardized cognitive testing.
Complete physical and neurological examination
Order labs and imaging as indicated
Test biomarkers for Alzheimer’s disease, when appropriate, according to the decision tree

After the visit

Interpret findings
Use the decision tree
Determine diagnosis
Consider referral
Document findings

REDCap Full Assessment Technical Tutorial

Purpose of the REDCap form

The REDCap version of the ACCT-AD assessment form allows convenient access to key components of the evaluation. The REDCap form supports structured collection and documentation of information during an in-person or telehealth diagnostic evaluation of cognitive and behavioral symptoms. It can be used by clinicians, nurses, social workers, care navigators, medical assistants, and other members of the care team. In theory, patients and informants could respond to the questions on their own, but practices would need to develop an approach to obtain a summary of these responses for the provider.

Key features

Structured clinical history
Built-in interpretation tables
Hover-over prompts
Red flag identification
Automated summary report
Export to PDF or copy into the EMR

What is on the form?

The form provides specific wording to elicit responses for each part of the clinical history, including the history of present illness (HPI), a review of the cognitive, behavioral, and motor systems, and spaces to document the neurological examination, laboratory results, and imaging findings. The examiner can use the form as a guide to remind them of what to ask and do, to interpret what they hear and see, or to record all of their findings. If the interviewer/examiner wishes to use the form to record their findings, they can document the presence or absence of each symptom and sign, and enter additional details provided by the patient or informant. After completion, the examiner can submit the form to generate a summary of the findings, which can be copied and pasted into the EMR, printed, saved as a PDF, and potentially emailed.

These same questions are also available in downloadable PDFs on the assessment forms and tools page. The advantages of the REDCap form are that the questions, prompts, and interpretation tables can all be accessed easily from one page, and the interviewer/examiner can input their findings electronically and generate a summary if they wish.

How does the form work?

The REDCap form allows input of clinical information pertaining to cognitive, behavioral, and motor changes. It is designed for clinician input, but also allows input from a patient or an informant. The information provider can indicate their identity.

ACCT-AD information provider choice — **Figure 1.** Initial setup of the REDCap Full Assessment. The clinician identifies the respondent (patient, care partner, both, or medical staff) and records the language of administration and other demographic information that guide subsequent sections of the assessment.

The form provides opportunities to input relevant information about the evaluation, including the language of administration and the patient's education level. If the patient did not complete college, the toolkit provides links to additional information on cognitive testing for individuals with lower levels of formal education.

If the information provider indicates that they are medical staff, the form will subsequently give additional options for how the toolkit will be used. After the last demographic questions, there will be an option to indicate whether they would like to use the form to record their HPI, as well as probe for additional cognitive, behavioral, and motor changes

ACCT-AD full HPI choice question — **Figure 2a.** Optional History of Present Illness (HPI) documentation. Clinicians may use the REDCap form to document the HPI directly or use it to guide symptom assessment and interpretation.

If the clinician answers yes, they will be given spaces to record that information (figure below). If they choose no, they can document their HPI elsewhere and use the form only to probe for additional symptoms.

ACCT-AD full HPI fields — **Figure 2b.** History of Present Illness (HPI) documentation section after it has been enabled. The form provides structured fields, interpretation tables, and prompts to guide documentation of the patient's history.

Similarly, near the end of the form, they are given the opportunity to indicate whether they would like to use it to document their exam and laboratory findings (see figure below). Again, if they choose "no," they can document these findings elsewhere.

ACCT-AD exam fields — **Figure 3.** Optional physical and neurological examination section. Clinicians may document examination findings directly within the REDCap form or use the section as a structured guide during the clinical evaluation.

The core of the form is the individual questions that probe for important changes in cognitive, behavioral, or motor function. An example is provided below for visuospatial function.

ACCT-AD_lost_driving_question — **Figure 4.** Example symptom question for visuospatial function. Each question includes links to interpretation tables and optional prompts that help clinicians obtain consistent clinical information.

For each question, the form also provides prompts, if needed, to guide the clinician, patient, and informant on what kinds of problems are commonly seen as examples of the area being asked about. These prompts are accessed by hovering over the link.

ACCT-AD driving lost prompts — **Figure 5.** Prompts for question about getting lost

If the response to the question is 'yes', the clinician is expected to ask for additional details and examples, so that they can evaluate the changes, as shown in the figure below

ACCT-AD driving lost response — **Figure 6.** Example of documenting additional clinical details after a symptom is endorsed. Clinicians are prompted to record examples and indicate whether the finding represents an atypical finding ("red flag").

If the clinician is unsure whether this is a typical response for aging, typical for a disorder like Alzheimer's disease, or possibly indicative of a less common form of neurodegenerative disease, they can consult the interpretation table by hovering over the link (see figure below). If this is an unusual symptom, they can indicate this by checking whether it is a red flag. In the case above, the symptom is concerning but typical for AD and thus is not a red flag for the purposes of ACCT-AD. In this case, the toolkit does not identify any responses that likely indicate an atypical symptom.

ACCT-AD driving lost interp table — **Figure 7.** Example interpretation table accessed by hovering over the interpretation link. The table provides examples of normal aging, symptoms typical of Alzheimer's disease, and findings that may warrant **consideration of referral** to a dementia specialist.

Submitting the assessment and generating a report

Once the examiner/interviewer has completed the assessment, they can SUBMIT the responses to the database using the button at the end of the form, which will generate a formatted report highlighting endorsed symptoms, red flags, and key findings. The summary can be copied into the electronic medical record, printed, or saved as a PDF to support documentation and clinical decision-making.

Click this link to see a sample report