Table 4.

Practice recommendations for domain 3 “evaluation” with steps to implement the recommendation [19, 47, 58, 60–68]

PR	Steps, options, or solutions to implement each recommendation
PR 3.1 Professionals assessing cognitive function should take into account the impact of hearing and vision impairments on cognitive evaluations	Appointment letters should remind patients to bring their best-corrected hearing aids and glasses to the appointments (PPI/PC)
	Increased awareness of environmental issues (see PR 6.2), that is, conduct testing in a quiet environment, one-on-one, and ensure the individual can see the test administrator’s face and gestures (TF)
	If not already undertaken, screening for hearing/vision should be undertaken (see PR 2.2)
	Consider which tests/assessment processes for evaluating PwD are suitable given HVC status - validated versions and grading systems of routine cognitive assessments that do not depend on vision and/or hearing are available and should be used if vision/hearing loss suspected [58, 60, 61]
	Routine provision of low-cost sensory-corrective devices (i.e., amplifiers and magnifiers) during cognitive testing may aid in obtaining accurate assessments [62, 63]
	Bring family members to help recall on the PwD’s history on vision and/or hearing problem (PC/PPI)
	Clinicians may need to raise awareness of other conditions and how they impact on assessment to the patient and care giver (PC/PPI)
	Give more time during the assessment (PC/PPI)
PR 3.2 Professionals assessing hearing should take into account the impact of vision and cognitive impairments on hearing evaluations	Appointment letters should remind patients to bring their best-corrected glasses to appointments and provide information ahead of time about what to expect at the appointment for hearing assessment (PPI/PC)
	Increased awareness of environmental issues (see PR 6.2)
	Allow adequate time for appointments with opportunities for breaks [19] (PC/PPI)
	Consider domiciliary evaluation if appropriate [64]
	Include caregiver/family members to help recall on the PwD’s history on hearing problem and allow to accompany during the whole appointment [64] (PC/PPI)
	Approach the assessment flexibly, it may be difficult for patients to follow instructions and do things which they once did [19] (PC/PPI)
	Consider alternative approaches to assess hearing abilities, such as presenting pulsed tones instead of continuous tones [64]
	If cognitive status is unknown and sufficient training has been undertaken, consider asking relevant questions to probe cognitive status or performing adapted or sensory-appropriate versions of cognitive screens before the hearing evaluation to find out the patient’s cognitive status ability to properly perform the evaluation (PC/PPI)
PR 3.3 Professionals assessing vision should take into account the impact of hearing and cognitive impairments on evaluations of vision	Appointment letters should remind patients to bring their best-corrected hearing aids to appointments and provide information ahead of time about what to expect at the appointment for visual assessment (PPI/PC)
	Increased awareness of environmental issues (see PR 6.2), that is, conduct testing in a quiet environment, one-on-one, and ensure the individual can see the test administrator’s face and gestures (TF)
	Allow adequate time for appointments with opportunities for breaks [19] (PC/PPI)
	Consider domiciliary evaluation visits if appropriate [19]
	Include caregiver/family members to help recall on the PwD’s history on hearing problem and allow to accompany during the whole appointment [64] (PC/PPI)
	Consider alternative approaches to assess visual acuity such as Teller Acuity Cards and ETDRS-letter chart that may work across a spectrum of cognitive impairment [65–67]
	Guidance for working with patients with visual loss and acquired cognitive impairment or dementia exists. For example, in the UK, the Royal College of Opthalmologists have produced quality statements [68] and the College of Optometrists have produced guidance for examining patients [47]
	Routine provision of low-cost amplification devices during testing may aid in obtaining accurate assessments, at minimum when providing instructions [62]
	Approach the assessment flexibly; it may be difficult for patients to follow instructions and do things which they once did; consider simple, shorter, objective tests, rather than subjective measures [19] (PC/PPI)
	If cognitive status is unknown, and sufficient training has been undertaken, consider asking relevant questions to probe cognitive status or performing adapted or sensory-appropriate versions of cognitive screens before the vision evaluation to find out the patient’s cognitive status ability to properly perform the evaluation (PC/PPI)

PR, practice recommendation; PwD, people living with dementia; PC/PPI, professional consortia and/or patient and public involvement groups.