麻豆传媒

A quick cognitive assessment tool helped improve dementia-related care in primary care patients, a randomized controlled trial showed.

Compared with a control intervention, the 5-Cog system tripled the odds that a patient would receive a dementia-related intervention within 90 days (18.5% vs 6.8%, P<0.001), reported Joe Verghese, MBBS, MS, of the Albert Einstein Medical College in the Bronx, New York, and co-authors.

The primary outcome was defined as one of five actions -- a new diagnosis of dementia or mild cognitive impairment; imaging, tests, or prescriptions ordered; or a specialist referral -- within 90 days. The adjusted odds ratio (OR) for the primary outcome (OR 3.43, 95% CI 2.32–5.07) and its components were higher in the 5-Cog arm than the control group.

"Dementia is often undiagnosed in primary care, and even when diagnosed, untreated," Verghese and colleagues wrote in . "The 5-Cog paradigm, a brief, culturally adept, cognitive detection tool paired with a clinical decision support may reduce barriers to improving dementia diagnosis and care."

Primary care cognitive tests can be long or require specialized personnel, Verghese and colleagues noted. Often, they don't provide guidance on the next steps if a patient has a normal or abnormal result, they added.

"Many cognitive tests were developed in white populations," the researchers pointed out. "These tests, therefore, do not adequately account for cultural differences or health inequity."

For example, the Montreal Cognitive Assessment (MoCA) test were established in mostly white populations and were too high in a study of mostly Black or Hispanic people, they observed. Black and Hispanic participants in the Health and Retirement Study had more frequently than white participants, they added.

The 5-Cog tool combines three metrics designed to test memory recall, the connection between cognition and gait, and the ability to match symbols and pictures. The tests are quick and not affected by reading levels or ethnic or cultural differences among patients, Verghese and co-authors said. They can be administered by non-physicians who can convey results to a primary care provider.

In the , the 5-minute cognitive assessment was coupled with a decision tree embedded in a patient's electronic medical record (EMR). The researchers enrolled 1,201 older adults who presented to one urban primary care clinic in the Bronx with cognitive concerns from May 2019 to September 2022. All participants lived in zip codes designated as socioeconomically disadvantaged neighborhoods.

Mean age of participants was about 73. Most (72%) were women and 94% were Black, Hispanic, or Latino. About 40% did not graduate from high school.

Overall, 599 participants were assigned to the 5-Cog group and 602 to the control group. The control intervention was matched for time and tester exposure. It included elements that did not overlap with the 5-Cog, like grip strength instead of gait assessments.

Dementia-care actions occurred in 43.8% patients with positive 5-Cog results and 1.4% with negative 5-Cog. New primary care diagnoses of mild cognitive impairment (7.3% vs 0.8%) and dementia (3.5% vs 1.5%) were higher in the 5-Cog arm than the control group. Those in the 5-Cog group had more laboratory tests (OR 7.64), imaging tests (OR 4.80), and specialist referrals (OR 2.38) for cognitive indications than the control group (all P<0.001). New prescriptions were rare in both groups (1.0% vs 0.3%).

Overall, 1,042 participants completed 12 months of follow-up. No group differences in hospitalizations or emergency department differences were seen over 12 months.

The study has several limitations, Verghese and colleagues acknowledged. It was conducted at a single center and involved only patients with memory concerns, not asymptomatic older adults.

"Following up on this clinical efficacy trial, we have begun a that will examine the clinical effectiveness of the 5-Cog paradigm, including the critical aspect of integration of results with recommendations for follow-up in the EMR, in 22 primary care clinics as well as evaluate implementation issues and economic impact," they wrote.

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