Digital Assessment of Cognitive Health in Outpatient Primary Care (Preprint)

Abstract

BACKGROUND Screening for cognitive impairment in primary care is important, yet primary care physicians (PCPs) report conducting routine cognitive assessments for less than half of patients over 60 years of age. Linus Health’s Core Cognitive Evaluation (CCE), a tablet-based digital cognitive assessment, has been validated for the detection of cognitive impairment but is not yet used in clinical practice at UMass Memorial Medical Center. OBJECTIVE We explored the integration of CCE implementation in a primary care setting. METHODS A convenience sample was recruited from the upcoming schedules of participating PCPs at UMass Memorial Medical Center. Eligibility criteria included age ≥65 years; ability to read, write, and speak in English or Spanish; no prior diagnosis of cognitive impairment; and no known untreated hearing or vision impairment. Research coordinators consented participants and facilitated the screening process. PCPs reviewed reports in real-time, immediately before the scheduled visits, and shared results at their discretion. A report was uploaded to each participant’s REDCap record and linked to the encounter in the electronic health record. Feedback from patients and their caregivers (if applicable) was collected by a tablet-based survey in the clinic before and after screening. Participating PCPs were interviewed following the completion of the study. RESULTS The screened cohort consisted of 150 patients (mean age 74 ± 7 years, 65% female). The CCE identified 40 patients as borderline and 7 patients as positive for cognitive impairment. As a result of taking the CCE, only 1% of patients reported feeling sad or depressed, and 5% reported feeling worried or anxious. More than two-thirds of patients reported that taking the CCE was beneficial. All the 15 surveyed caregivers reported they would want to know if their loved one's brain health was declining. A majority of participating PCPs stated that the results of the CCE changed their patient care management (6 of 7), and all 7 PCPs reported they would continue using the CCE if made available following the study. CONCLUSIONS We explored the integration of the CCE into primary care visits, which showed minimal disruption to the practice workflow. Future studies will be warranted to further validate the implementation of digital cognitive impairment screening tools within primary care settings in the real world. CLINICALTRIAL