Meeting NewsPerspective

Simple tools used in cognitive assessment visits enable PCPs to diagnose dementia

Kevin Parks
Kevin Ryan Parks

Dementia-related tools common to several medical societies and organizations that can be used by primary care physicians in diagnosing dementia, according to data presented at the American Geriatric Society Annual Scientific Meeting.

“Access to specialty clinics is limited; there is a need to develop a high-value model of dementia care into primary care setting,” Kevin Ryan Parks, MD, geriatrics fellow at the Mayo Clinic, and colleagues wrote.

Researchers noted clinical areas were PCPs said they had “low confidence.” They then used dementia tools from CMS, the Alzheimer’s Association and American Academy of Neurology to develop a sample cognitive assessment visit that addressed the PCPs’ knowledge gaps.

The prototype included guidance on obtaining patients’ cognitive decline histories; performing structured functional and cognitive assessments, medication reconciliations, and safety evaluations; providing advanced care planning and appropriate referrals; and creating a follow-up plan.

Parks and colleagues reported that in 27 PCP-patient visits that implemented the prototype, either formal cognitive testing was performed, activities of daily living were recorded, a safety checklist was provided or screening for depression occurred during more than 75% of the visits and sometimes in as many as 96% of them, leading to 19 dementia diagnoses.

The prototype’s implementation did have some difficulties, Parks told Healio Primary Care.

“The various scales and tools are time consuming to administer. To maximize our time spent face-to-face with patients and family during education and counseling, we are working with our nursing and allied-health professionals to find more effective methods,” he said in an interview.

He noted that the frequency of dementia and the toll the disease takes should encourage PCPs to overcome barriers when creating their own cognitive assessment visit template.

“The impact of dementia on an individual, family, and society cannot be understated. One new case of dementia occurs each 7 seconds,” Parks said.

“The first medical professional patients and caregivers will address concerns about their memory with is likely to be their primary care provider, so PCPs should be aware that patients and caregivers have concerns about cognition, and cognitive assessment visits are possible and reimbursable,” he added. – by Janel Miller

Reference: Parks KR, et al. “A new approach to dementia care: Cognitive consults integrated within the primary care practice.” Presented at: American Geriatrics Society Annual Scientific Meeting. May 2-4, 2019, Portland, Oregon.

Disclosure: Parks reports no relevant financial disclosures. The other authors’ relevant financial disclosures could not be determined prior to publication.

Kevin Parks
Kevin Ryan Parks

Dementia-related tools common to several medical societies and organizations that can be used by primary care physicians in diagnosing dementia, according to data presented at the American Geriatric Society Annual Scientific Meeting.

“Access to specialty clinics is limited; there is a need to develop a high-value model of dementia care into primary care setting,” Kevin Ryan Parks, MD, geriatrics fellow at the Mayo Clinic, and colleagues wrote.

Researchers noted clinical areas were PCPs said they had “low confidence.” They then used dementia tools from CMS, the Alzheimer’s Association and American Academy of Neurology to develop a sample cognitive assessment visit that addressed the PCPs’ knowledge gaps.

The prototype included guidance on obtaining patients’ cognitive decline histories; performing structured functional and cognitive assessments, medication reconciliations, and safety evaluations; providing advanced care planning and appropriate referrals; and creating a follow-up plan.

Parks and colleagues reported that in 27 PCP-patient visits that implemented the prototype, either formal cognitive testing was performed, activities of daily living were recorded, a safety checklist was provided or screening for depression occurred during more than 75% of the visits and sometimes in as many as 96% of them, leading to 19 dementia diagnoses.

The prototype’s implementation did have some difficulties, Parks told Healio Primary Care.

“The various scales and tools are time consuming to administer. To maximize our time spent face-to-face with patients and family during education and counseling, we are working with our nursing and allied-health professionals to find more effective methods,” he said in an interview.

He noted that the frequency of dementia and the toll the disease takes should encourage PCPs to overcome barriers when creating their own cognitive assessment visit template.

“The impact of dementia on an individual, family, and society cannot be understated. One new case of dementia occurs each 7 seconds,” Parks said.

“The first medical professional patients and caregivers will address concerns about their memory with is likely to be their primary care provider, so PCPs should be aware that patients and caregivers have concerns about cognition, and cognitive assessment visits are possible and reimbursable,” he added. – by Janel Miller

Reference: Parks KR, et al. “A new approach to dementia care: Cognitive consults integrated within the primary care practice.” Presented at: American Geriatrics Society Annual Scientific Meeting. May 2-4, 2019, Portland, Oregon.

Disclosure: Parks reports no relevant financial disclosures. The other authors’ relevant financial disclosures could not be determined prior to publication.

    Perspective

    As the incidence and prevalence of dementia increases, the need for appropriate assessment and treatment of memory complaints in primary care will become ever more important. Early identification of cognitive impairment and competency in its differential diagnosis is a skill that providers will need in their daily practice as delay in diagnosis can have significant implications.

    This quality improvement project organized by Parks et al aims to address this growing need in primary care by first identifying barriers and then integrating memory assessment and care in that setting. Working alongside primary care providers and in patients’ homes, consulting geriatricians used validated tools in a multipronged approach to patient evaluation. In a visit separate from the routine medical visit, the geriatricians were able to assess the patient’s cognitive function, psychosocial factors, functional status and behaviors, which are key in the evaluation and management of dementia. Through their work, they were able to identify new dementia diagnoses, counsel patients (and families), and have important discussions about the diagnosis.

    While improving recognition of dementia in primary care is needed, a high value model of dementia care will also focus on the management of this permanent and progressive condition. As current pharmacologic treatments show only modest effects on cognition, providers should have a grasp of nonpharmacologic care including a team-based approach (physician, nurse case management, social worker, pharmacy, etc.), available community resources and approaches to manage behavioral and psychological symptoms of dementia. Throughout the disease course, the patient remains the focus, but integrating family, friends and caregiver(s) early is beneficial because they often serve as informants about cognitive changes, help implement and monitor management techniques and provide context in disease progression. Given their role, family and caregivers should be connected to available community resources aimed at educating them on dementia care. Furthermore, assessing for caregiver stress and strain as dementia progresses is an integral part of dementia care as caregiver burden can impact patient care and lead to early institutionalization.

    In order to improve dementia care, health care systems will need to create more “space” for cognitive evaluation and care. This space (ie, education/training, time provisions, dedicated care teams, etc.) will equip physicians with the necessary tools to manage dementia in the primary care setting. Parks et al have developed a road map to this space, starting with integrating geriatricians into the primary care clinic on a small scale in hopes of increasing awareness and education. Armed with the necessary tools, primary care providers will be able to adopt similar approaches to improve diagnosis and management of patients with dementia in their everyday practice.  

    • Jarrod A. Carrol, MD
    • Jarrod A. Carrol, MD Geriatrician, Memory Assessment and Care Clinic Department of geriatrics, palliative medicine and continuing care, West Los Angeles Kaiser Permanente Medical Center, Los Angeles

    Disclosures: Carrol reports no relevant financial disclosures.

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