Researchers at the University of Colorado Anschutz have unveiled a groundbreaking approach to identifying hoarding behaviors in individuals suffering from cognitive impairments and neurodegenerative disorders. Their innovation, a streamlined one-question screening tool developed to aid clinicians, promises to revolutionize the diagnostic process in neurologic and psychiatric care settings. By enabling rapid assessment of hoarding tendencies—an often overlooked but impactful symptom—this tool could significantly improve patient outcomes and caregiver well-being.
Hoarding disorder, characterized by persistent difficulty discarding possessions regardless of their actual value, can culminate in hazardous living environments and heightened psychological distress. Traditionally viewed through the lens of psychiatric illnesses such as obsessive-compulsive disorder, hoarding behaviors are also increasingly recognized among people afflicted by dementia, Alzheimer’s disease, and other debilitating neurocognitive diseases. This overlap of psychiatric and neurologic domains underscores the urgent need for effective screening techniques sensitive to a broad spectrum of underlying etiologies.
Conventional evaluations of hoarding tendencies have hinged upon intensive, time-consuming diagnostic interviews and comprehensive questionnaires. These resource-heavy methodologies are impractical in fast-paced clinical environments such as primary care or memory clinics, where patient throughput and limited consultation times hinder extensive assessments. Addressing this bottleneck, the University of Colorado team engineered the Single-Item Hoarding Screen (SIHS)—a deceptively simple question posed to caregivers designed to serve as a swift and efficient initial filter for hoarding risk.
The SIHS asks caregivers a singular, straightforward question: “Is there any concern regarding clutter in the home or possible hoarding behavior?” with response options spanning “no,” “maybe,” and “yes.” This minimalist approach leverages caregiver insights as crucial indicators, as they often witness behavioral changes and functional declines not readily apparent to health professionals during brief clinical encounters. By capturing these real-world observations, the SIHS bridges the gap between clinical evaluation and daily lived experience.
In a recent observational study involving 135 patients evaluated at a specialized behavioral neurology clinic, research leaders including Dr. Peter Pressman and Julia Schaffer investigated the screen’s efficacy. The cohort represented diverse neurodegenerative diagnoses, ranging from Alzheimer’s disease and Lewy body dementia to primary progressive aphasia and behavioral variant frontotemporal dementia. This diversity provided a robust test bed for the question’s sensitivity across heterogeneous disease profiles.
Remarkably, 23% of caregivers expressed some level of concern regarding hoarding behavior, with 10% affirming and 13% expressing uncertainty about its presence. Those affirming the presence of hoarding (“yes” responders) demonstrated significantly elevated scores on established hoarding severity instruments, confirming the SIHS’s capacity to flag clinically meaningful cases with a single query. This correlation reinforces the validity of caregiver-reported observations as powerful diagnostic proxies.
Beyond confirming hoarding status, the study uncovered associations between hoarding concerns and broader neuropsychiatric contexts. Patients identified as hoarders displayed more pronounced depressive symptoms, amplified neuropsychiatric disturbances, and correspondingly heightened caregiver burden. These findings illuminate the multifaceted impact of hoarding behaviors—extending far beyond clutter to engender emotional distress and caregiver fatigue—thereby justifying an urgent clinical response.
Particularly striking was the prevalence of hoarding behaviors among individuals diagnosed with behavioral variant frontotemporal dementia. This subtype is distinguished by marked impairments in impulse control and executive function, implicating neural circuits critical for decision-making and behavior regulation. The observed linkage suggests that neurodegeneration disrupting these frontal brain regions may precipitate or exacerbate hoarding tendencies, offering insights into the neuropathological underpinnings of compulsive accumulation.
The implications of the SIHS extend into practical clinical realms. In busy memory clinics where extensive behavioral inventories are often untenable, a validated one-question screen like the SIHS can facilitate the early identification of problematic hoarding. Early detection opens avenues for timely intervention, which might include environmental modifications, behavioral therapies, and caregiver support mechanisms tailored to mitigate the cascading negative consequences of hoarding.
Despite these promising preliminary data, study authors emphasize the preliminary nature of their findings and the necessity for further validation. Broader, multicenter trials involving heterogeneous patient populations are essential to confirm the tool’s reliability, scalability, and cross-cultural applicability. These future investigations will establish standardized protocols to integrate the SIHS seamlessly into routine neurologic and psychiatric assessments.
The creation of the SIHS underscores an important evolution in neuropsychiatric screening philosophy—from comprehensive but cumbersome tools to precise, streamlined instruments that leverage caregiver input effectively. This paradigm shift reflects the growing recognition that detection strategies must reconcile clinical rigor with operational feasibility to ensure that critical symptoms do not remain obscured in fast-paced healthcare settings.
Ultimately, the introduction of the Single-Item Hoarding Screen has the potential to transform how clinicians approach and manage hoarding behaviors in cognitively impaired populations. By illuminating a previously under-recognized aspect of neurodegenerative disease phenotypes, this tool not only advances diagnostic accuracy but also contributes to holistic care strategies that prioritize both patient safety and caregiver well-being.
The University of Colorado Anschutz’s work in pioneering this tool aligns with its mission to lead transformative advances in neuroscience and patient care. Supported by multidisciplinary collaboration and robust funding, the research exemplifies how targeted innovations can address nuanced challenges in brain health, paving the way for improved quality of life in vulnerable populations.
As the healthcare community embraces these innovations, the combined efforts of neurologists, psychiatrists, caregivers, and researchers will be critical in refining intervention paradigms. Tools like the SIHS herald a future where subtle yet impactful symptoms such as hoarding are no longer neglected but are promptly identified and managed within integrated care frameworks.
Subject of Research: People
Article Title: A Single-Item Screening Tool for the Assessment of Hoarding: Preliminary Observations
News Publication Date: February 26, 2026
Web References: https://psychiatryonline.org/doi/10.1176/appi.neuropsych.20250152#sec-4
Keywords: Neurology, Behavioral neuroscience, Social neuroscience, Cognitive neuroscience
