WASHINGTON – Routine use of a simple dementia screening tool can boost the number of possible dementia cases identified in primary care without putting a substantial drain on physician time, according to data presented at an international conference sponsored by the Alzheimer's Association.
After institution of dementia screening for all patients 65 years old and older in two primary care clinics, the number of dementia diagnoses made by geriatricians and primary care physicians rose significantly. The number of diagnoses did not change at two other primary care facilities that served as controls, said Soo Borson, M.D., professor of geriatric psychiatry at the University of Washington in Seattle.
For the trial, dementia screening was performed by medical assistants who had been specially trained in administering and interpreting the Mini-Cog test, developed by Dr. Borson and her colleagues. Data from electronic records at two other primary care clinics served as controls.
The Mini-Cog screening test takes 1–3 minutes to administer and involves a three-item recall portion to assess memory and a clock-drawing test. The Mini-Cog is as effective as, if not better than, the Mini-Mental State Examination in identifying cognitive impairment, she said. A score of 0–2 on a scale of 5 indicates impairment.
The medical assistants informed physicians of the results and entered the results into the patient's medical record.
The medical assistants had a 96% agreement rate with the expert raters. The researchers identified the percentage of the clinic caseload comprising dementia diagnoses, dementia referrals, cognitive impairment referrals, or prescriptions of cholinesterase inhibitors in the year following the start of cognitive screening.
Of the 540 patients eligible for screening at the test clinics, 70% were successfully screened; fewer than 1% refused. Of those screened, 16% scored below the Mini-Cog cut point of 3.
Prior to use of the screening tool, 11% of patients seen by the geriatricians were diagnosed with dementia, compared with 4% of those seen by primary care physicians.
After screening was introduced, the number of patients diagnosed with dementia rose to 15% for geriatricians and 6% for primary care physicians. In comparison, of the 1,143 patients treated at the control clinics, only 2% had a dementia diagnosis both years.
The increase in the number of patients identified with cognitive problems at the test clinics didn't necessarily translate into more care for dementia.
“Even for geriatricians, less than 50% of people diagnosed with dementia were actively treated for it,” Dr. Borson said at the meeting.
Primary care referrals to specialists for suspected dementia also increased in response to screening but did not change in control clinics.
Prescribing of medications for dementia increased slightly, but only among nongeriatricians in the test clinics. “This shows that screening has some effect, but isn't a sufficient intervention,” Dr. Borson told this newspaper.
The findings show that screening can improve recognition of possible dementia.
Based on this and other studies by Dr. Borson's group, simple screening tools like the Mini-Cog appear to help the most with identifying the less cognitively impaired individuals whom physicians often miss.