A new five-minute cognitive assessment tool significantly improves dementia care actions in primary care settings. This tool, known as 5-Cog, tripled the likelihood of patients receiving dementia-related care within 90 days.
The 5-Cog assessment, combined with a decision tree embedded in electronic medical records, was evaluated in a clinical trial funded by the National Institutes of Health (NIH). The study, published in Nature Medicine, involved 1,200 predominantly Black and Hispanic American older adults who reported cognitive concerns in an urban primary care setting. The results demonstrated a marked improvement in dementia diagnosis and subsequent care.
How 5-Cog Works: A Quick and Effective Dementia Assessment Tool for Dementia Care
5-Cog employs three simple metrics: memory recall, the correlation between cognition and gait, and symbol-to-picture matching. These tests are designed to be easily administered, quick to complete, and unaffected by literacy levels or cultural backgrounds, ensuring equitable access to assessment.
Prior to their physician consultations, patients were quickly screened for cognitive impairment using 5-Cog. Physicians then used a decision tree integrated within the patient’s electronic medical record to determine appropriate follow-up care. Participants were randomly assigned to either the 5-Cog group or a control group receiving standard care.
Significant Improvement in Dementia Care Actions
Compared to standard care, the 5-Cog system tripled the odds of patients receiving dementia-related care within 90 days. This care encompassed new diagnoses of dementia or mild cognitive impairment, further assessments, medication prescriptions, and referrals to specialists. The findings highlight the potential of incorporating tools like 5-Cog into primary care practices to overcome barriers and enhance dementia follow-up care.
In busy primary care settings, diagnosing cognitive impairment can be challenging, leading to underutilization of beneficial care plans. Early detection is crucial for timely intervention, support services, and critical planning. The study suggests that 5-Cog may be particularly valuable for older Black and Hispanic patients, who experience higher rates of underdiagnosis compared to their white counterparts.
Addressing Disparities in Dementia Diagnosis
This research, funded by the NIH’s National Institute of Neurological Disorders and Stroke and the National Institute on Aging, underscores the importance of equitable access to dementia care. The 5-Cog study is part of the Consortium for the Detection of Cognitive Impairment, Including Dementia (www.detectcid.org). ClinicalTrials.gov identifier: NCT03816644.
The 5-Cog assessment tool represents a promising step toward improving dementia care and reducing disparities in diagnosis and treatment. By facilitating early detection and timely intervention, this innovative tool can significantly enhance the lives of individuals living with cognitive impairment and their families. The simplified assessment process and integration into existing electronic medical records make it a practical and scalable solution for primary care settings.
The full study, “Non-literacy biased, culturally fair cognitive detection tool in primary care patients with cognitive concerns: a randomized controlled trial,” can be found in Nature Medicine: DOI: 10.1038/s41591-024-03012-8
