Tuesday, June 11, 2024

Brief, Culturally Sensitive Screener Helps Primary Care Providers Diagnose Dementia

Older, socioeconomically disadvantaged patients with cognitive concerns were nearly three and a half times more likely to receive improved dementia care when a brief, culturally sensitive screening test was deployed at their primary care clinic, according to a study in Nature Medicine.

“Despite the availability of many cognitive assessment tools, dementia is often undiagnosed; over half of dementia cases are missed in primary care. This problem is more prevalent among older Black and Hispanic people than older white people in the United States,” wrote Joe Verghese, M.D., M.S., at the Albert Einstein College of Medicine in Bronx, N.Y., and colleagues.

Verghese and colleagues enrolled 1,200 older adults with cognitive concerns (average age 73; predominantly Black or Hispanic) who resided in economically disadvantaged neighborhoods in Bronx County. Participants’ cognition was evaluated at their primary care clinic, with half receiving a frailty/grip strength test and a health literacy assessment and half receiving the 5-Cog, a non-language-based assessment that incorporates photographic recall, symbol matching, and a gait test. Both evaluations were administered by research assistants and were paired with a set of recommendations in the electronic medical records to assist doctors when making dementia care choices.

Patients screened with 5-Cog were 3.43 times more likely to receive improved dementia care within 90 days compared with the control group; improved care included receiving a new diagnosis of mild cognitive impairment (MCI) or dementia or the ordering of lab tests, imaging, medication prescriptions, or specialist referrals for cognitive indications. The majority of the 242 participants in the 5-Cog group who received a diagnosis were given the diagnosis on the same day as their assessment (89%). New prescriptions were rare in both groups (1.0% versus 0.3%).

The researchers acknowledged that MCI and dementia classifications were not based on a neuropsychological evaluation, but such an evaluation “takes over an hour and is neither routine nor practical for detecting cognitive impairment in primary care. This approach is reflective of the real world.” The researchers also noted that their results do not apply to asymptomatic patients, calling for a study on the utility of the 5-Cog in a general primary care population.

For more information, see the Psychiatric News article “Common Dementia Screening Tests Often Misclassify Patients.”

(Image: Getty Images/iStock/FatCamera)

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