Faculty Bibliography

In December 2017, the National Academy of Neuropsychology convened an interorganizational Summit on Population Health Solutions for Assessing Cognitive Impairment in Geriatric Patients in Denver, Colorado. The Summit brought together representatives of a broad range of stakeholders invested in the care of older adults to focus on the topic of cognitive health and aging. Summit participants specifically examined questions of who should be screened for cognitive impairment and how they should be screened in medical settings. This is important in the context of an acute illness given that the presence of cognitive impairment can have significant implications for care and for the management of concomitant diseases as well as pose a major risk factor for dementia. Participants arrived at general principles to guide future screening approaches in medical populations and identified knowledge gaps to direct future research. Key learning points of the summit included: recognizing the importance of educating patients and healthcare providers about the value of assessing current and baseline cognition; emphasizing that any screening tool must be appropriately normalized and validated in the population in which it is used to obtain accurate information, including considerations of language, cultural factors, and education; and recognizing the great potential, with appropriate caveats, of electronic health records to augment cognitive screening and tracking of changes in cognitive health over time. Summit Participants Deb Adler¹, Christopher Alban, MD, MBA², Mark Bondi, PhD³, Michelle Braun, PhD⁴, Xavier Cagigas, PhD⁵, Morgan Daven⁶, Robert L. Denney, PsyD^7,8, Lisa Drozdick, PhD⁹, Norman L. Foster, MD^10,11, Ula Hwang, MD^12–15, Laurie Ivey, PsyD¹⁶, Grant Iverson, PhD^7,17, Joel Kramer, PsyD¹⁸, Laura Lacritz, PhD^7,19, Melinda Lantz, MD²⁰, Lisa Latts, MD, MSPH, MBA²¹, Shari M. Ling, MD²², Ana Maria Lopez, MD^23–26, Michael Malone, MD^27,28, Lori Martin-Plank, PhD, MSN, MSPH, RN²⁹, Katie Maslow, MSW³⁰, Don Melady, MSc(Ed), MD^31–33, Melissa Messer³⁴, John Meyers, PsyD⁷, Charles E. McConnel, PhD¹⁹, Randi Most, PhD³⁶, Margaret P. Norris, PhD³⁷, William Perry, PhD^7,85,39, Neil Pliskin, PhD⁴⁰, David Shafer, MBA⁴¹, Nina Silverberg, PhD⁴², Tresa Roebuck-Spencer, PhD^43,44, Colin M. Thomas, MD, MPH⁴⁵, Laura Thornhill, JD⁴⁶, Jean Tsai, MD, PhD^10,47, Nirav Vakharia, MD⁴⁸, Martin Waters, MSW⁴⁹ Organizations Represented Alzheimer’s Association, Chicago, IL AMA/CPT Health Care Professionals Advisory Committee, Chicago, IL American Academy of Clinical Neuropsychology (AACN), Ann Arbor, MI American Academy of Neurology (AAN), Minneapolis, MN American Association of Geriatric Psychiatry (AAGP), McLean, VA American Association of Nurse Practitioners (AANP), Austin, TX American Board of Professional Neuropsychology (ABN), Sarasota, FL American College of Emergency Physicians (ACEP), Philadelphia, PA American College of Physicians (ACP), Philadelphia, PA American Geriatrics Society (AGS), New York, NY American Psychological Association (APA), Washington, DC Beacon Health Options, Boston, MA Canadian Association of Emergency Physicians, Ottawa, ON, Canada Collaborative Family Healthcare Association (CFHA), Rochester, New York Gerontological Society of America, Washington, DC Hispanic Neuropsychological Society (HNS), Los Angeles, CA IBM Watson Health, Denver, CO International Federation of Emergency Medicine, West Melbourne, Australia International Neuropsychological Society (INS), Salt Lake City, UT National Academy of Neuropsychology (NAN), Denver, CO Optum of UnitedHealth Group, Minneapolis, MN Pearson, New York City, New York Psychological Assessment Resources, Inc, Lutz, FL Society for Clinical Neuropsychology, Washington, DC U.S. Department of Veterans Affairs, Washington, DC *Please note that participation in the Summit does not constitute organizational endorsement of this report

In December 2017, the National Academy of Neuropsychology convened an interorganizational Summit on Population Health Solutions for Assessing Cognitive Impairment in Geriatric Patients in Denver, Colorado. The Summit brought together representatives of a broad range of stakeholders invested in the care of older adults to focus on the topic of cognitive health and aging. Summit participants specifically examined questions of who should be screened for cognitive impairment and how they should be screened in medical settings. This is important in the context of an acute illness given that the presence of cognitive impairment can have significant implications for care and for the management of concomitant diseases as well as pose a major risk factor for dementia. Participants arrived at general principles to guide future screening approaches in medical populations and identified knowledge gaps to direct future research. Key learning points of the summit included: recognizing the importance of educating patients and healthcare providers about the value of assessing current and baseline cognition;emphasizing that any screening tool must be appropriately normalized and validated in the population in which it is used to obtain accurate information, including considerations of language, cultural factors, and education; andrecognizing the great potential, with appropriate caveats, of electronic health records to augment cognitive screening and tracking of changes in cognitive health over time.

In December 2017, the National Academy of Neuropsychology convened an interorganizational Summit on Population Health Solutions for Assessing Cognitive Impairment in Geriatric Patients in Denver, Colorado. The Summit brought together representatives of a broad range of stakeholders invested in the care of older adults to focus on the topic of cognitive health and aging. Summit participants specifically examined questions of who should be screened for cognitive impairment and how they should be screened in medical settings. This is important in the context of an acute illness given that the presence of cognitive impairment can have significant implications for care and for the management of concomitant diseases as well as pose a major risk factor for dementia. Participants arrived at general principles to guide future screening approaches in medical populations and identified knowledge gaps to direct future research. Key learning points of the summit included: recognizing the importance of educating patients and healthcare providers about the value of assessing current and baseline cognition; emphasizing that any screening tool must be appropriately normalized and validated in the population in which it is used to obtain accurate information, including considerations of language, cultural factors, and education; and recognizing the great potential, with appropriate caveats, of electronic health records to augment cognitive screening and tracking of changes in cognitive health over time.

BACKGROUND: The incidence of well-differentiated thyroid cancer (WDTC) is increasing rapidly. Many authors feel that this increase is due to over-diagnosis and that one of the contributing factors is the increasing use of various imaging studies. The rate of obesity has also been increasing in the United States. It has been suggested that patients with an increased body mass index (BMI kg/m2) have a higher incidence of WDTC than patients with normal BMI. One might hypothesize that thyroid nodules are more difficult to palpate in obese patients and that as more cancers are detected by imaging the apparent rate of increase in WDTC in obese patients would appear to be greater than in non-obese patients. This study was undertaken to evaluate this hypothesis by determining if there is any difference in the way thyroid cancers are initially detected in obese and non-obese patients. METHODS: The medical records of all 519 patients with a postoperative diagnosis of WDTC who underwent thyroidectomy at NYU Langone Medical Center from January 1, 2007 through August 31, 2010 by the three members of NYU Endocrine Surgery Associates were reviewed. Patients were divided into Non-obese (BMI<30 kg/m2) and Obese (BMI>/=30 kg/m2) groups. Patients were also divided by the initial method of detection of their tumor into Palpation, Imaging, and Incidental groups. RESULTS: The final study group contained 270 patients, 181(67%) of whom were in the Non-obese Group and 89(33%) were in the Obese Group. In the Non-obese group, 81(45%) of tumors were found by palpation, 72(40%) were found by imaging, and 28(16%) were found incidentally. In the Obese group, 40(45%) were found by palpation, 38(43%) were found by imaging, and 11(12%) were found incidentally. These differences were not statistically significant (p-value 0.769). CONCLUSION: We show that BMI does not play a role in the method of initial detection in patients with WDTC. This suggests that the prevalence of WDTC detected by imaging is not an artifact caused by an increasingly obese population and that any association of WDTC and obesity is not related to the way in which these tumors are detected.