One of the first studies to examine the prevalence of unrecognized cognitive impairment among patients in Federally Qualified Health Centers found it to be pervasive, especially among minority populations. These facilities provide primary care and preventive services, regardless of their payment options or health insurance status, to more than 30 million patients, including a growing number of older adults.
Early and fair detection of cognitive impairment can benefit patients and their families. Delaying diagnosis leads to poor health outcomes for patients and their care partners and limits access to resources for treatment and care management services.
The study of 204 socially and economically vulnerable older adults (average age 70 years) found that African American individuals were more than twice as likely to have unrecognized cognitive impairment (mild cognitive impairment or dementia).
About 82 percent of black patients had undiagnosed dementia or mild cognitive impairment, compared with 64 percent of white patients. Only 26 percent of all study participants had no cognitive impairment.
The study population consisted of just over half African Americans and was predominantly female. The association between race and cognitive impairment did not differ by gender, age, or year of education.
On average, each study participant received primary care for three chronic medical conditions, such as diabetes, heart disease, high blood pressure, or chronic obstructive pulmonary disease, and took five medications.
To make the diagnosis, patients and relatives were interviewed, patients’ medical records were reviewed for three years, and extensive cognitive testing and neurological examinations were performed.
We know from our previous work that there is a stigma attached to the diagnosis of cognitive impairment and the fear of loss of independence. So it is unlikely that the patient, and often their care partner, will ask the GP to check the health of the patient’s brain. To provide quality care and overcome inequities and stigma, we must develop scalable, timely, equitable, and sustainable approaches, strategies, processes, and tools for the early detection of cognitive impairment in primary care generally and specifically in Federally Qualified Healthcare . Centers, which primarily serve low-income and medically underserved communities.
Early detection would give patients and care partners access to three recent breakthroughs in brain care. One of these is the availability of amyloid-lowering therapy that may alter the trajectory of cognitive and functional decline in people with Alzheimer’s disease. Number two is the Centers for Medicare and Medicaid Services’ (CMS) new alternative payment model to help cover the costs of providing comprehensive dementia care services, including support for care partners.
Third, early detection opens the door to reducing the risk of future cognitive disorders by implementing lifestyle changes that target blood pressure, diabetes, cholesterol, sleep and depression, as well as cognitive and physical exercise.
Malaz Boustani, study senior author, MD, MPH
Using machine learning to extract information captured in the medical notes of a patient’s electronic health record, Dr. Boustani and colleagues developed and tested a low-cost, scalable methodology to detect cognitive impairment or facilitate the early detection of individuals at risk of developing dementia. They call it zero-minute assessment for less than a dollar and see it as a culturally sensitive solution – a healthcare system redesign – to a problem that the healthcare system has neither the time nor financial capital to solve.
The study authors write: “The differences in diagnoses by race are likely due to both a higher prevalence of dementia in this subgroup and a lack of embedded workflows that support detection and timely diagnosis in these patients due to patient, physician, and healthcare factors. that need to be addressed urgently.”
“Prevalence of Unrecognized Cognitive Impairment in Federally Qualified Health Centers” is published in JAMA Network Open. The study was funded by the National Institute on Aging of the National Institutes of Health, grant R01AG069765 (PIs: Malaz Boustani, Zina Ben Miled, and James Galvin).
The authors of the study from the Regenstrief Institute, in addition to Dr. Boustani, his research scientist Nicole Fowler, PhD, MHSA, and Arthur Owora, PhD, MPH, and affiliate scientist Zina Ben Miled, PhD.
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Magazine reference:
Kulshreshtha, A., et al. (2024). Prevalence of unrecognized cognitive impairment in federally qualified health centers. JAMA network opened. doi.org/10.1001/jamanetworkopen.2024.40411.