Investigators at Albert Einstein College of Medicine, Montefiore Health System, Regenstrief Institute, and Indiana University School of Medicine have received an $11 million grant from the National Institutes of Health (NIH) to evaluate an Einstein-developed test for assessing cognitive impairment and dementia. The 5-minute screening tool was designed for people from a range of racial and ethnic backgrounds, education levels and socioeconomic circumstances with the goal of reducing disparities in pre-dementia and dementia diagnosis and treatment and improving dementia care overall.
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."
Joe Verghese, M.B.B.S., M.S., principal investigator on the grant and 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 Einstein and Montefiore
The rising tide of Alzheimer's
According to the Alzheimer's Association, 6.5 million Americans older than 65 are living with Alzheimer's disease, and the number is expected to rise to 12.7 million by 2040. But not all people are equally affected: 19% of African Americans and 14% of Hispanics age 65 and older are diagnosed with Alzheimer's, compared to 10% of whites. Despite this, Black participants in Alzheimer's disease research studies were 35% less likely to be diagnosed than white participants and were diagnosed with more severe symptoms.
Traditionally, neurologists diagnose Alzheimer's or its precursor, mild cognitive impairment (MCI), after a lengthy evaluation. This poses a significant challenge for many groups: people with limited access to specialized care (including people from historically marginalized groups) as well as people living in poverty, in rural areas, or who require a referral from a primary care physician who may not recognize their symptoms.
"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," said Malaz Boustani, M.D., M.P.H., co-principal investigator on the grant and the founding director of the Center for Health Innovation and Implementation Science at the IU School of Medicine. "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." He also is a research scientist at Regenstrief Institute.
A novel test
The 5-Cog assessment involves a picture-based memory-impairment screening test, a short picture-based symbol match, and confirmation that a patient has cognitive complaints and problems with mobility. Previous research has found that the image-based assessment effectively negates influences resulting from a person's preferred language, education level, and gender. Having previously validated the 5-Cog assessment at one clinical site, the researchers will now evaluate the test in real-world primary care settings.
The study will enroll 6,600 participants presenting with cognitive concerns in 22 primary care clinics in the Bronx 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 be provided with a decision tree to ensure patients receive appropriate follow-up care and support.
"Earlier diagnosis and treatment of dementia and MCI may enable people to remain in their homes longer and will help families make appropriate plans," said Dr. Verghese. "It also gives people the opportunity to modify their lifestyle to improve the trajectory of their disease."
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