Dementia: New Screening Tool to be Evaluated in Primary Care

A new 5-minute screening tool for Alzheimer’s disease could become part of the patient examination process for primary care physicians.

Researchers hope to reduce racial, ethnic, educational, and socioeconomic disparities in diagnosing predementia and dementia, while improving dementia care overall. The US National Institutes of Health has awarded $11 million for a collaborative effort to evaluate the screening test.

“With Alzheimer’s becoming increasingly common, we must find a way to involve more physicians in diagnosing the disease and its precursor conditions and directing people to the appropriate care and supportive services,” grant principal investigator Joe Verghese, MBBS, MS, said in a news release.

Verghese is chief of the unified divisions of geriatrics in the department of medicine and cognitive & motor aging in the Saul R. Korey Department of Neurology at Albert Einstein College of Medicine and Montefiore Health System. They will join with the Regenstrief Institute and Indiana University School of Medicine to test the new screening tool.

Prevalence rising

The Alzheimer’s Association states 6.5 million American aged 65 years or older are living with the disease and that number is projected to rise to 12.7 million by 2040. For those aged 65 years and older, the disease affects 10% of Whites, 14% of Hispanics, and 19% of Blacks, yet in research studies, Black patients were 35% less likely to be diagnosed than White patients.

Tests can take lengthy evaluations, which can be a challenge for those in rural or underserved areas – or who require a referral from a primary care physician who may not recognize symptoms, according to the researchers.

“Primary care physicians are on the front lines of caring for those with dementia, but it is challenging for them to make diagnoses – in fact, more than 50% of dementia cases are missed during primary care appointments,” Malaz Boustani, MD, MPH, said in the news release.

“Primary care physicians are on the front lines of caring for those with dementia, but it is challenging for them to make diagnoses – in fact, more than 50% of dementia cases are missed during primary care appointments.”

The new test, called the 5-Cog screening paradigm, “seeks to address this challenge by providing a tool that does not require special equipment or training, is inexpensive, available in English and Spanish, and takes only five minutes,” Boustani said in the news release.

Boustani, a research scientist at Regenstrief Institute, is coprincipal investigator on the grant and the founding director of the Center for Health Innovation and Implementation Science at the IU School of Medicine.

Take the test

The 5-Cog assessment, available in English and Spanish, uses picture-based tests that aim to negate influences from patients’ preferred languages, education, and gender. The study will enroll 6600 participants presenting with cognitive concerns in 22 primary care clinics in the Bronx, New York, and Indiana. Primary care teams will be prompted to give the assessment by the electronic medical record system. Responses will be automatically classified as “normal” or “abnormal” based on results, and care teams will use a decision tree to ensure patients receive follow-up care.