At a glance, in older persons, a five-minute, culturally neutral test for cognitive issues enhanced dementia screening and management. The basic tool could enable persons living throughout the United States, even in underprivileged places, to have more access to dementia care.
In the United States, around six million older persons live with dementia. Though dementia is somewhat widespread, studies show that in hectic primary care environments, doctors typically overlook symptoms of cognitive impairment. Older Black and Hispanic Americans especially should be aware of this.
Early diagnosis of dementia or its predecessor, mild cognitive impairment, is crucial to enable therapies and planning to help older persons stay safe in their home environment. Many of the conventional tests for dementia assess facets of cognition, including memory, learning, and thinking. These tests, however, can take a lot of time and money and call for qualified doctors to administer. Many were also developed in White populations, hence they might have cultural prejudices that render them less successful among more varied groups.
Under the direction of Dr. Joe Verghese of Albert Einstein College of Medicine, a research team created a culturally objective cognitive evaluation tool called 5-Cog to help busy, varied primary care offices diagnose dementia. The team intended 5-Cog for usage among elderly persons worried about their cognitive ability.
Three short tests—of memory recall, the link between cognition and locomotion, and the capacity to match symbols to images—make up the instrument. Should the findings point to cognitive difficulties, 5-Cog immediately notes it in the patient’s electronic health record. This results in a set of suggestions being forwarded to their physician. The entire 5-Cog process lasts roughly five minutes and can be given by someone without medical knowledge.
Under an NIH grant, the team examined 5-Cog in over 1,200 older persons drawn from a Bronx County, New York City primary care clinic. Every study subject resided in a poor area. Of nearly three-quarters, women, 94% said their race was Black, Hispanic, or Latino. About forty percent had never completed high school.
The patients were randomized to receive either 5-Cog or an unrelated physical test (the control group) prior to a primary care appointment. Published in Nature Medicine on June 4, 2024, the findings. Compared to slightly under 7% of patients in the control group, almost 20% of older persons who underwent the 5-Cog test had superior overall dementia treatment.
Those who completed the 5-Cog test also showed notable improvements in a number of individual aspects of dementia treatment. These comprised additional tests, a fresh diagnosis of dementia or mild cognitive impairment, and expert referrals within ninety days following the examination. Over the next year, there was no appreciable variation between groups in hospitalisations or ER visits.
“We hope that the results of this study will encourage changes in primary care practice so that more older people with mild cognitive impairment or dementia will benefit from diagnosis and treatment for their conditions,” Verghese notes.
Additional research is under process, including a clinical trial to see whether 5-Cog can detect early cognitive impairments in elderly persons without cognitive complaints. It also has to be tested across several populations.
Funding: National Institute of Ageing (NIA) and National Institute of Neurological Diseases and Stroke (NINDS).