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Randomized Controlled Trial
. 2024 Aug;30(8):2356-2361.
doi: 10.1038/s41591-024-03012-8. Epub 2024 Jun 4.

Non-literacy biased, culturally fair cognitive detection tool in primary care patients with cognitive concerns: a randomized controlled trial

Joe Verghese  1   2 , Rachel Chalmer  3 , Marnina Stimmel  4 , Erica Weiss  4 , Jessica Zwerling  4 , Rubina Malik  3 , David Rasekh  5 , Asif Ansari  3   5 , Roderick A Corriveau  6 , Amy R Ehrlich  3 , Cuiling Wang  5   6 , Emmeline Ayers  4
Affiliations
Randomized Controlled Trial

Non-literacy biased, culturally fair cognitive detection tool in primary care patients with cognitive concerns: a randomized controlled trial

Joe Verghese et al. Nat Med. 2024 Aug.

Abstract

Dementia is often undiagnosed in primary care, and even when diagnosed, untreated. The 5-Cog paradigm, a brief, culturally adept, cognitive detection tool paired with a clinical decision support may reduce barriers to improving dementia diagnosis and care. We performed a randomized controlled trial in primary care patients experiencing health disparities (racial/ethnic minorities and socioeconomically disadvantaged). Older adults with cognitive concerns were assigned in a 1:1 ratio to the 5-Cog paradigm or control. Primary outcome was improved dementia care actions defined as any of the following endpoints within 90 days: new mild cognitive impairment syndrome or dementia diagnoses as well as investigations, medications or specialist referrals ordered for cognitive indications. Groups were compared using intention-to-treat principles with multivariable logistic regression. Overall, 1,201 patients (mean age 72.8 years, 72% women and 94% Black, Hispanic or Latino) were enrolled and 599 were assigned to 5-Cog and 602 to the control. The 5-Cog paradigm demonstrated threefold odds of improvement in dementia care actions over control (odds ratio 3.43, 95% confidence interval 2.32-5.07). No serious intervention-related adverse events were reported. The 5-Cog paradigm improved diagnosis and management in patients with cognitive concerns and provides evidence to promote practice change to improve dementia care actions in primary care.ClinicalTrials.gov: NCT03816644 .

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Study flow.
Flow diagram for study participants.
Fig. 2
Fig. 2. Outcome rates by study arm.
Proportion of participants in the 5-Cog (blue) and control (grey) study arms who met improved dementia care outcome as well as individual criterion by 90 days.
See this image and copyright information in PMC

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References

    1. 2022 Alzheimer’s disease facts and figures. Alzheimers Dement.10.1002/alz.12638 (2022).
    1. Chalmer, R. et al. The 5-Cog paradigm to improve detection of cognitive impairment and dementia: clinical trial protocol. Neurodegener. Dis. Manag.12, 171–184 (2022). - PMC - PubMed
    1. Borson, S., Scanlan, J. M., Watanabe, J., Tu, S. P. & Lessig, M. Improving identification of cognitive impairment in primary care. Int. J. Geriatr. Psychiatry21, 349–355 (2006). - PubMed
    1. Mattke, S. et al. Expected and diagnosed rates of mild cognitive impairment and dementia in the US. Medicare population: observational analysis. Alzheimers Res. Ther.15, 128 (2023). - PMC - PubMed
    1. Holsinger, T. et al. Screening for cognitive impairment: comparing the performance of four instruments in primary care. J. Am. Geriatr. Soc.60, 1027–1036 (2012). - PubMed

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