Brief Cognitive Screens at Primary Care Visits Effective
(HealthDay News) – Brief cognitive screening of older patients combined with further evaluation, if needed, in the primary care setting leads to a two- to three-fold increase in the diagnosis of cognitive impairment, including dementia, according to a study published in the February issue of the Journal of the American Geriatrics Society.
John Riley McCarten, MD, of the Veterans Affairs Medical Center in Minneapolis, and colleagues assessed a quality improvement initiative at seven Veterans Affairs Medical Centers. Veterans (≥70 years old) who failed a brief cognitive screen (Mini-Cog score <4/5) at a routine primary care visit were offered a further, comprehensive evaluation; this evaluation was performed by an advance practice registered nurse trained in dementia care and integrated into the primary care clinic. The cases of veterans who completed the evaluation were reviewed in a consensus conference, and a diagnosis of dementia; cognitive impairment, no dementia; or no cognitive impairment was assigned.
The researchers found that, of 8,342 veterans offered the screening, 8,063 (97%) accepted and 2,081 (26%) failed the screen. Of the 580 (28%) who agreed to further evaluation, 540 (93%) were diagnosed with cognitive impairment, including 432 (75%) with dementia. For screen passes requesting further evaluation, 87% (103/118) had cognitive impairment, including 70% (82/118) with dementia. Among veterans who failed the screen but declined further evaluation, 17% (259/1,501) were diagnosed with incident cognitive impairment through standard care; this brought the total value of newly documented cognitive impairment in all screens to 11% (902/8,063), versus 4% (1,242/28,349) in similar clinics without this program.
"Screening combined with offering further evaluation increased new diagnoses of cognitive impairment in older veterans two to three times," the authors write.