Cognitive assessments and conversations about brain health are not part of routine visits to the doctor’s office, even though 4 in 5 Americans say they would want to know if they had Alzheimer’s disease before having symptoms. With more than 7 million Americans living with Alzheimer’s and that number projected to double by 2060, early detection is crucial. Writing in MedPage Today, Dr. Barak Gaster shares groundbreaking results from a two-year initiative called Cognition in Primary Care, that could transform how we catch cognitive impairment before it progresses to dementia.
“We deployed a practical, scalable package of clinical tools and training among all 94 primary care providers working at 14 community-based clinics serving 330,000 patients across Western Washington. The aim was to increase detection of cognitive impairment in everyday primary care practice. The results were striking.”
“In the 9 months following implementation, we saw a seven-fold increase in cognitive testing entered into the health record using the highly effective Montreal Cognitive Assessment — from fewer than three to nearly 20 tests conducted per month. More importantly, physicians diagnosed more than twice as many patients with mild cognitive impairment or dementia — from six to 14 per month. These outcomes suggest that with the right workflow and educational support, primary care physicians can identify significantly more patients with cognitive impairment.”
Improving the state of dementia care starts with a focus on early detection. Mild Cognitive Impairment (MCI) involves memory and thinking problems that differ from normal aging. More often than not, MCI is a precursor to dementia. Alzheimer’s is the most common form of dementia, making up 60-80% of cases. Catching MCI early can open the door to earlier detection and diagnosis of Alzheimer’s disease, when the therapeutic window is widest.
Today it is possible to reliably detect signs of Alzheimer’s with a simple blood test. FDA-approved treatments for early symptomatic Alzheimer’s have been shown to slow the disease progression over a prolonged period. And yet, underdiagnosis remains a major barrier to progress. As Alzheimer’s cases rise in the U.S., health care practices are seeking out new models for detecting cognitive impairment that are feasible within the resourced-constrained primary care setting. Equipping primary care doctors to diagnose dementia earlier also reduces dependence on scarce neurologists and expensive PET scans that remain inaccessible to many patients, especially in rural communities.
“Building on these results, and with funding support from the Alzheimer’s Association, the Cognition in Primary Care team will now partner with the American Academy of Family Physicians to offer an adaptation of the program to its 130,000 members using AAFP’s “office champions” model. The aim will be to identify 25 primary care offices who will voluntarily (at no cost) adopt the program, tracking its outcomes to understand the impact on patients and channel insights to strengthen program expansion. We need approaches like this to answer the growing challenge of undiagnosed dementia, and we need them now.” [...]
“We have the tools and know-how to ensure people with late life cognitive impairment get better care. The challenge is to bring these workflows into everyday practice. Mild cognitive impairment and dementia are among the many chronic conditions that are already being managed in primary care. With better training and tools, primary care can level up their skill at identifying and treating these conditions to better meet the needs of our aging population.”
Dr. Gaster’s work offers a replicable blueprint for transforming dementia care at scale. Cognition in Primary Care has improved clinical outcomes while working within the operational realities of existing primary care practices. The question is no longer whether models exist to improve early detection in primary care, but whether health care systems can move fast enough to meet the coming demand.
You can read the full piece here.
