Feasibility and Acceptability of Implementing a Digital Cognitive Assessment for Alzheimer Disease and Related Dementias in Primary Care

PLAIN-LANGUAGE SUMMARY

Original Research

Digital Cognitive Assessment in Primary Care May Enable Early Dementia Detection and Next Step Care

Background and Goal: Many adults aged 65 and older never receive a cognitive check during regular primary care visits. This study  assessed the feasibility and acceptability of implementing a digital cognitive assessment for Alzheimer disease and related dementias (ADRD) screening into primary care. They also assessed the prevalence of positive screens and measured diagnostic and care outcomes after a positive digital cognitive assessment result. 

Study Approach: From June 2022 to May 2023, seven Indiana University Health clinics offered the five-minute Digital Clock & Recall test on an iPad to every patient 65 and older. Each site, after a series of pre-launch “sprint” meetings, set its own rules on which visit types and which staffers would run the screen, then uploaded results to the electronic record for the physician to review. In month three, researchers introduced a registered-nurse role to support patients for completing care pathways if they were flagged for cognitive impairment. Physicians retained discretion over follow-up, and investigators recorded every lab, imaging study, referral and new diagnosis ordered within 90 days of the screen.

Main Results                    

• Of the 16,708 patients who were identified as eligible for screening, a total of 1,808 digital cognitive assessments (10.8%) were completed by 1,722 unique patients.

• More than one-half (55.3%) of eligible visits never offered the digital cognitive assessment because PCPs declined or the encounter was deemed out of scope during sprint meetings.

• Screening outcomes: Among 1,808 tests, 44.3% were categorized as unimpaired, 36.5% as borderline, and 13.7% as impaired.

• Follow-up within 90 days for the impaired group: 2.1% received a new Alzheimer or related-dementia diagnosis; 5.1% received a new mild cognitive impairment diagnosis; 16.9% had brain imaging ordered; 62.7% were referred to the brain health navigator.

Why It Matters: Many cases of cognitive impairment go undetected in primary care. Digital cognitive assessments may offer a feasible way to screen older adults during routine visits, helping identify those who may benefit from early diagnosis, treatment, and care planning. However, without supportive workflows and follow-up systems in place, these tools alone aren’t enough to close the gap in dementia care.         

Feasibility and Acceptability of Implementing a Digital Cognitive Assessment for Alzheimer Disease and Related Dementias in Primary Care 

Nicole R. Fowler, PhD, MHSA, et al                     

Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana