A five-minute cognitive assessment coupled with a decision tree embedded in electronic medical records, known as 5-Cog, improved dementia diagnosis and care, based on a clinical trial funded by the National Institutes of Health (NIH) and conducted in an urban primary care setting.
Researchers evaluated the system among 1,200 predominantly Black and Hispanic American older adults who presented to primary care with cognitive concerns. The findings appear in Nature Medicine.
5-Cog combines three metrics designed to test memory recall, the connection between cognition and gait, and the ability to match symbols to pictures. Importantly, these tests are easy to perform, relatively quick, and are not affected by reading level or ethnic/cultural differences among patients.
Using 5-Cog, patients were rapidly assessed for cognitive impairment before seeing their physicians, who then determined follow-up care using a decision tree within the patients’ electronic medical records. Study participants were randomly assigned to receive either the 5-Cog assessment or to a control group that received standard care. Use of the 5-Cog system improved the odds three-fold that a patient would receive dementia-related care compared to standard care. Such dementia-related care included a new diagnosis of dementia or mild cognitive impairment, as well as further assessments, medications, or specialist referrals within 90 days. The findings provide evidence that changes to medical practice in primary care like the adoption of the 5-Cog system could reduce barriers and improve dementia follow-up care.
