Despite the increasing rates of cognitive complaints in older adults, cognitive impairment related to dementia is frequently under-diagnosed in primary care settings. Most of the available cognitive assessment tests are generally not practical for use by primary care physicians, and do not address the technical, cultural and logistic barriers for people from diverse communities. Traditionally, neurologists diagnose Alzheimer’s disease or its precursor—mild cognitive impairment—after a detailed and lengthy evaluation. This poses a significant challenge for many groups, including people from historically marginalized populations with limited access to specialized care, as well as those living in poverty, in rural areas, or who require a referral from a primary care physician who may not recognize their symptoms. 

The Montefiore Einstein-initiated 5-Cog assessment represents a novel, standardized, and brief and easy-to-use cognitive assessment tool designed for use in diverse settings with the goal to reduce disparities in pre-dementia and dementia diagnosis and treatment. Through an interdisciplinary collaboration between the Montefiore Einstein Department of Neurology division of cognitive and motor aging, and the Indiana University School of Medicine, our clinician scientists are validating the clinical efficacy of this assessment tool for clinical decision making within the primary care setting. 

As a feature of this study, we will be enrolling older adult participants presenting with cognitive concerns from numerous primary care clinics in the Bronx and Indiana, including NIH-designated health disparity populations. Primary care teams will be prompted to give the assessments via an 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.

The 5-Cog assessment battery, available in English and Spanish, includes a picture-based memory-impairment screening test, a short picture-based symbol match, and confirmation that a patient has cognitive complaints as well as problems with mobility. Preliminary observations from a randomized clinical trial that we are conducting at a primary care clinic in the Bronx, revealed that this screening battery resulted in an over eight-fold increase in new cognitive impairment diagnoses, and an over three-fold increase in improved dementia care by primary care physicians.  

If you are interested in enrolling a patient into this clinical trial, please call 718-920-2000. 

https://classic.clinicaltrials.gov/ct2/show/NCT05515224