New clinical assessment tool improves dementia care actions in primary care patients

Resource tripled the odds of receiving dementia-related care within 90 days.

What

A five-minute cognitive assessment coupled with a decision tree embedded in electronic medical records, known as 5-Cog, improved dementia diagnosis and care, based on a clinical trial funded by the National Institutes of Health (NIH) and conducted in an urban primary care setting. Researchers evaluated the system among 1,200 predominantly Black and Hispanic American older adults who presented to primary care with cognitive concerns. The findings appear in Nature Medicine.

5-Cog combines three metrics designed to test memory recall, the connection between cognition and gait, and the ability to match symbols to pictures. Importantly, these tests are easy to perform, relatively quick, and are not affected by reading level or ethnic/cultural differences among patients.

Using 5-Cog, patients were rapidly assessed for cognitive impairment before seeing their physicians, who then determined follow-up care using a decision tree within the patients’ electronic medical records. Study participants were randomly assigned to receive either the 5-Cog assessment or to a control group that received standard care. Use of the 5-Cog system improved the odds three-fold that a patient would receive dementia-related care compared to standard care. Such dementia-related care included a new diagnosis of dementia or mild cognitive impairment, as well as further assessments, medications, or specialist referrals within 90 days. The findings provide evidence that changes to medical practice in primary care like the adoption of the 5-Cog system could reduce barriers and improve dementia follow-up care.

Cognitive impairment is often difficult to diagnose in the busy primary care setting and, as a result, beneficial care plans are likely underutilized. This can result in lack of detection, which delays the start of support services and critical planning. Underdiagnosis is even more prevalent among older Black and Hispanic patients compared to white patients, suggesting this tool may be even more valuable to the populations represented in the study.

The research was funded by NIH’s National Institute of Neurological Disorders and Stroke (UG3NS105565 and U01NS105565) in collaboration with NIH’s National Institute on Aging. The 5-Cog study is a participant in the Consortium for the Detection of Cognitive Impairment, Including Dementia (www.detectcid.org). ClinicalTrials.gov identifier: NCT03816644.

Who

Roderick Corriveau, Ph.D., program director, NINDS Division of Neuroscience

Article

Verghese J, et al. Non-literacy biased, culturally fair cognitive detection tool in primary care patients with cognitive concerns: a randomized controlled trial. Nature Medicine. 4 June 2024. DOI: 10.1038/s41591-024-03012-8

NINDS is the nation’s leading funder of research on the brain and nervous system. The mission of NINDS is to seek fundamental knowledge about the brain and nervous system and to use that knowledge to reduce the burden of neurological disease.

About the National Institute on Aging (NIA): NIA leads the U.S. federal government effort to conduct and support research on aging and the health and well-being of older people. Learn more about age-related cognitive change and neurodegenerative diseases via NIA’s Alzheimer’s and related Dementias Education and Referral (ADEAR) Center website. Visit the main NIA website for information about a range of aging topics in English and Spanish, and stay connected.

About the National Institutes of Health (NIH):
NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

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