JMIR Publications

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 used for the detection of cognitive impairment but its application in primary care is not yet studied.

Objective:

We explored the integration of CCE implementation in a primary care setting.

Methods:

A cohort of participants 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 included 150 patients with a mean age of 74 ± 7 years, of whom 65% were female. The CCE identified 40 patients as borderline and 7 as positive for cognitive impairment. Eighty-four orders were placed for select lab tests or referrals to neurology and neuropsychology within 20 days of CCE administration. Prior to the assessment, 95% of patients and all 15 caregivers expressed a desire to know if their or their loved one’s brain health was declining. Following the assessment, 96% of patients reported finding the CCE easy to complete, and 70% felt the experience was beneficial. Additionally, 88% of patients agreed or strongly agreed that they wanted to know their CCE results. Among the seven participating PCPs, six stated that the CCE results influenced their patient care management, and all seven indicated they would continue using the CCE if it were made available after 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.