Lessons from Detecting Cognitive Impairment Including Dementia (DetectCID) in Primary Care

Article type: Research Article

Authors: Bernstein Sideman, Alissa^{a; b; c; d} | Chalmer, Rachel^e | Ayers, Emmeline^f | Gershon, Richard^g | Verghese, Joe^{e; f} | Wolf, Michael^{h; i} | Ansari, Asif^e | Arvanitis, Marina^{h; i} | Bui, Nhat^j | Chen, Pei^k | Chodos, Anna^k | Corriveau, Roderick^l | Curtis, Laura^h | Ehrlich, Amy R.^e | Tomaszewski Farias, Sarah E.^m | Goode, Collette^j | Hill-Sakurai, Lauraⁿ | Nowinski, Cindy J.^{g; o} | Premkumar, Mukundⁿ | Rankin, Katherine P.^j | Ritchie, Christine S.^{p; q; r} | Tsoy, Elena^j | Weiss, Erica^f | Possin, Katherine L.^{c; d; j; *}

Affiliations: [a] Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA | [b] Department of Humanities & Social Sciences, University of California, San Francisco, San Francisco, CA, USA | [c] Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA | [d] Trinity College Dublin, the University of Dublin, Dublin, Ireland | [e] Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA | [f] The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA | [g] Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA | [h] Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA | [i] Center for Applied Health Research on Aging (CAHRA), Feinberg School of Medicine, Northwestern University, Chicago, IL, USA | [j] Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA | [k] Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA | [l] National Institute of Neurological Disorders & Stroke, National Institute of Health, Bethesda, MA, USA | [m] Department of Neurology, University of California, Davis, Davis, CA, USA | [n] Department of Family and Community Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA, USA | [o] Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA | [p] Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA | [q] Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, MA, USA | [r] Harvard Medical School, Boston, MA, USA

Correspondence: [*] Correspondence to: Katherine L. Possin, PhD, Associate Professor in Residence, University of California, San Francisco, San Francisco, CA, USA. E-mail: Katherine.possin@ucsf.edu.

Abstract: Background:Cognitive impairment, including dementia, is frequently under-detected in primary care. The Consortium for Detecting Cognitive Impairment, including Dementia (DetectCID) convenes three multidisciplinary teams that are testing novel paradigms to improve the frequency and quality of patient evaluations for detecting cognitive impairment in primary care and appropriate follow-up. Objective:Our objective was to characterize the three paradigms, including similarities and differences, and to identify common key lessons from implementation. Methods:A qualitative evaluation study with dementia specialists who were implementing the detection paradigms. Data was analyzed using content analysis. Results:We identified core components of each paradigm. Key lessons emphasized the importance of engaging primary care teams, enabling primary care providers to diagnose cognitive disorders and provide ongoing care support, integrating with the electronic health record, and ensuring that paradigms address the needs of diverse populations. Conclusion:Approaches are needed that address the arc of care from identifying a concern to post-diagnostic management, are efficient and adaptable to primary care workflows, and address a diverse aging population. Our work highlights approaches to partnering with primary care that could be useful across specialties and paves the way for developing future paradigms that improve differential diagnosis of symptomatic cognitive impairment, identifying not only its presence but also its specific syndrome or etiology.

Keywords: Cognitive assessment, dementia, detection, diagnosis, implementation evaluation, mild cognitive impairment, primary care

DOI: 10.3233/JAD-215106

Journal: Journal of Alzheimer's Disease, vol. 86, no. 2, pp. 655-665, 2022