In the United States, over six million elderly individuals grapple with dementia. Despite its prevalence, the early warning signs of cognitive decline frequently go unnoticed in the bustling environment of primary care facilities, a situation that particularly affects older Black and Hispanic Americans. The early detection of dementia, or its preliminary stage known as mild cognitive impairment, is crucial. It opens the door to available treatments and enables planning to ensure the safety and wellbeing of seniors in their living environments.
While there are several established dementia assessments that evaluate cognitive abilities – the processes of thinking, learning, and remembering – these tests are often time-consuming, costly, and require the expertise of trained professionals to conduct. Moreover, the majority have been designed with White populations in mind, potentially introducing cultural biases that could hinder their effectiveness in a more multicultural society.
In response to the need for more inclusive and efficient diagnostic tools within diverse and high-paced primary care settings, a group of researchers led by Dr. Joe Verghese at the Albert Einstein College of Medicine has created the 5-Cog – a culturally neutral cognitive assessment device targeted at older adults expressing concerns regarding their mental faculties.
The 5-Cog comprises a trio of succinct examinations that evaluate memory recall, the connection between cognition and walking ability, and proficiency in matching symbols with images. Should the test indicate potential cognitive issues, it automatically signals an alert in the patient’s electronic health record. This action triggers a cascade of recommendations to be dispatched to their health care provider. The entire process encompassed by the 5-Cog is designed to be swift – roughly a five-minute duration – and does not necessitate medical expertise for administration.
Within the scope of an NIH-supported investigation, a 5-Cog assessment was administered to roughly 1,200 senior residents from an underserved community in the Bronx County primary care clinic in New York City. The demographic of the study population was primarily composed of individuals hailing from marginalized neighborhoods, where close to 75% were female, and a significant 94% identified themselves as being of Black, Hispanic, or Latino heritage. Approximately two-fifths of the cohort had not attained a high school diploma.
The study employed a randomized design, assigning participants either to undergo the 5-Cog assessment or to partake in a non-related physical examination functioning as the control measure, right before their primary care appointment. The revelations of the study saw publication in the June 4, 2024, edition of Nature Medicine.
Findings indicated a near 20% enhancement in comprehensive dementia care among the elderly participants screened with the 5-Cog, a stark contrast to the marginally under 7% improvement noted within the control faction. The 5-Cog participants also saw notable advancements in various specific domains of dementia care, ranging from newly issued diagnoses for dementia or mild cognitive impairment to subsequent evaluations and referrals to specialists within a 90-day post-assessment window.
The analysis further revealed no substantive differentiation in the frequency of hospitalizations or emergency department encounters over the subsequent year between the two groups.
Expressing optimism about the study’s implications, Dr. Verghese envisions the results as a catalyst for transforming primary care practices, paving the way for enhanced diagnosis and treatment rates among the elderly with mild cognitive impairment or dementia.
The research is poised to progress further, with an upcoming clinical trial aimed at determining the 5-Cog’s efficacy in spotting early-onset cognitive alterations in older adults who haven’t reported any cognitive issues, and its applicability across diverse populations still under examination.