Dementia Diagnosis: New Tool Boosts Care for Elderly

Globally common, dementia is a medical disorder that is frequently misunderstood and mistreated, especially in older Black and Hispanic people. Furthermore, researchers have often examined different facets of dementia care in isolation, without sufficient data to identify the approach that might improve dementia care in community centers dealing with health disparities.

In primary care settings, cognitive detection is hindered by time-consuming and costly procedures, physician use, specialized equipment, and a lack of guidance. Moreover, a large number of the tests used to detect dementia were first created for White people, ignoring cultural variations or inequities in health. These obstacles might be removed with the aid of cognitive identification, suggested follow-up activities, and expert referrals.

Concerning the study

The current single-blind randomized clinical trial (RCT) assesses whether clinical decision support with 5-Cog can enhance dementia diagnosis and treatment procedures.

The culturally sensitive 5-Cog paradigm or the control group was randomly assigned to individuals 65 years of age or older with cognitive impairments who spoke Spanish or English and sought care at an urban primary care clinic in Bronx County, New York.

The PMIS, symbol match, and the diagnosis of Motoric Cognitive Risk Syndrome (MCR) were all part of the study intervention. Researchers eliminated inhabitants of nursing homes, people with visual or hearing impairments, and anyone with a history of dementia or moderate cognitive impairment (MCI).

Better dementia care activities, such as new MCI syndrome or dementia diagnosis and investigations, medication, or specialist referrals for cognition-related causes within 90 days, were the main goals of the study.

Intention-to-treat principles were applied to evaluate the outcomes, and multivariable logistic regression analysis was used to derive odds ratios (ORs). Sensitivity analyses were performed to evaluate primary outcome data in ethnicity, gender, education, and language subgroups. To compare the results of those enrolled before and following the conclusion of the coronavirus disease 2019 (COVID-19), a post-hoc analysis was also conducted.

Study results

1,258 of the 4,538 people who were first identified qualified for the study. Between May 29, 2019, and September 15, 2022, 1,201 of these people were included in the study; 599 and 602 of them were assigned to the intervention group, and the control group, respectively.

Of the study’s participants, almost 72% were female, 49% were Black, 56% were Hispanic or Latino, and 40% had not finished high school. Every participant in the study lived in a region with low economic status.

Compared to 92% of controls on the visit day and one after one month, 89% of the 63 people who identified as having MCI or dementia received their diagnosis on the appointment day, six after one month, and one after two months.

When compared to the control group, the 5-CoG intervention was linked to a three-fold increase in the likelihood of enhancing dementia care activities. Except for innovative medications, individual dementia care activities were substantially greater among intervention beneficiaries.

Furthermore, compared to controls, the 5-Cog cohort had ORs of 6.5, 7.6, 4.8, and 2.4, respectively, for the number of MCI or dementia diagnoses, laboratory tests, imaging reports, and specialist referrals related to cognitive issues.

The intervention group had more dementia care interventions (19%) than the control group (6.8%). Just 1.4% of 5-Cog-negative study participants showed dementia care-related behaviors, compared to 44% of 5-Cog-positive participants.

The 5-Cog group had a greater incidence of incident dementia diagnosed by a primary care practitioner (PCP) (3.5% against 1.5%) and major cognitive impairment (MCI) (7.3% versus 0.8% of controls). In both groups, new prescriptions for medical care were infrequent.

There were no discernible variations between the groups’ rates of hospital stays or ER visits after a year. Furthermore, no noteworthy adverse events connected to the intervention were reported by the study subjects. Comparable outcomes were noted for research subjects both prior to and following the COVID-19 pandemic’s suspension.

In conclusion

It has been discovered that the 5-Cog tool enhances the diagnosis and treatment of patients with cognitive problems. Older primary care patients with cognitive impairments benefited three times from dementia care interventions.

The United States Preventive Task Force’s recommendations for racial and ethnic inequities are addressed, along with current implementation issues, via the 5-Cog tool. By taking into account gender, educational attainment, and language, this method also predicts primary outcomes for Black and Hispanic patients with accuracy. Crucially, this is a productive tool that is simple to use in clinical settings, especially those with limited resources and low-income communities.

For more information: Non-literacy biased, culturally fair cognitive detection tool in primary care patients with cognitive concerns: a randomized controlled trial, Nature Medicine, https://doi.org/10.1038/s41591-024-03012-8