CHSU Discovery

Abstract:

Introduction: Alzheimer’s dementia affects approximately 50 million people in the world and was the sixth leading cause of death in the United States in 2014 (Heron, 2016). The death rate due to Alzheimer’s increased by 55% from 1999 to 2014 (Centers for Disease Control and Prevention, 2017). Several studies have shown that in primary care, the majority of older adults with dementia are undiagnosed. Mild dementia is particularly under-diagnosed. In 2014, the U.S. Preventive Services Task Force concluded current evidence was not sufficient to assess the benefits of screening for cognitive impairment. Routine dementia screening in primary care using cognitive screening tools appeared to improve dementia case detection rates (Eichler et al., 2015). Primary care providers were often not sure which cognitive screening tool to use, and some had expressed reluctance to do the screening and use the screening tools due to lack of knowledge. The purpose of this QI project is to use one dementia screening tool that was easy to administer in primary care clinic to initiate intervention early and connect patients and their caregivers to community resources.  

Methods: Within Family medicine residency clinic, Mini-Cog was administered to 40 patients who are 65+ years with no previous history of dementia diagnosis during their standard annual wellness visit. Trained staff including Medical Assistants and Residents administered the test.  The Mini-Cog is a brief screening tool that is currently used in practice to screen for cognitive impairment using memory recall and a clock drawing test. Any participants who scored poorly
(score of 2 or below) underwent further work-up to rule out pseudodementia including
(depression screen, RPR test, TSH, and Vitamin B12 Deficiency) in addition, a referral to neurology and Alzheimer Association were placed for those participants who failed the Mini-Cog and Pseudodementia has been ruled out.  

Results and Discussion:  After IRB approval, 100 elderly patients (65+years) had been identified and scheduled in our clinic from June 2023-December 2023. Only 58 patients were qualified to participate. 15 patients did not show up for their appointments. Residents asked the remaining 43 qualified patients if they wanted to participate. Only 3 refused and total of 40 agreed to participate in the project.15 patients (37%) out of 40 patients failed and scored poorly on the Mini-Cog and underwent labs tests to rule out pseudodementia including (depression screen, RPR test, TSH, and Vitamin B12 Deficiency). 2 patients (13%) out of 15 tested positive for Vit B12 deficiency, and 6 patients (40%) out of 15 tested positive on PHQ-9 dementia screening. Only 7 patients (47%) out of 15 had negative pseudodementia screening and were referred to Memory Center and Alzheimer’s Association for more resources. This project also showed the providers in the primary care clinic indeed needed a dementia screening tool that was easy to use, practical, and sensitive in detecting cognitive impairment. Residents’ full participation in this project showed they were eager to learn more about dementia and implementing a quick and effective screening tool on dementia in their future practices.

Conclusion: We concluded that the Mini-Cog is an efficient and effective screening tool for cognitive impairment and helps patients and their families receive referrals, interventions, and community resources in a timely manner.