Cognitive Screening Made Easy for Primary Care Providers

Project Summary
In the United States and around the world, people are living longer lives. As the population ages, so does the
number of older adults who may experience declines in memory, attention, reasoning, or other thinking skills.
Some of these changes in cognition can be treated and reversed if caught early. Others can be slowed down
and hopefully one day prevented. Unfortunately, people with cognitive decline or very mild dementia often are
not recognized until late in the disease course when treatments are less effective. As the first health care
professional most people reach out to about medical concerns, primary care providers play a critical role in
detecting cognitive decline early. While many primary care providers conduct cognitive screening at Medicare
Annual Wellness Visits and when patients voice concerns, 9 out of 10 would like more information about who
to screen, which assessment tool to use, and what to say if screening is positive. Deciding who to screen with
a brief cognitive assessment tool is a key part of the process because not everyone needs to be screened, and
primary care providers already face time pressures to address the obvious and immediate concerns of their
patients. The long-term goal of this project is to develop a risk assessment and cognitive screening tool that
requires minimal time and effort from primary care providers or their staff and is sensitive to cognitive decline in
older adults from diverse educational and racial/ethnic backgrounds. The tool will be integrated into electronic
health record systems to make it easy for primary care providers and patients to see results. The specific aims
of the first phase of the project are to modify an existing dementia risk screening index to identify older adults
who are at high-risk for cognitive impairment, develop a brief cognitive assessment tool using tasks that are
easy for older adults to perform yet are sensitive to cognitive decline, confirm their utility in 150 people with
varying levels of cognitive abilities that have already been well defined, and test ways to integrate findings into
the electronic health record. The specific aims for the second phase are to further test the effectiveness of the
newly developed tool in 250 older adults receiving care in a primary care clinic, to find out from primary care
providers using the tool how much they liked it and if it was useful and easy to use, and to integrate findings
into multiple electronic health record systems. Findings from this project will fill a gap in the existing toolkit of
primary care providers and will make screening for cognitive decline quick, easy, and effective.

Grant Number: 5R33AG069780-05
NIH Institute/Center: NIH
Principal Investigator: Joshua Chang