Cognitive Assessment of Elderly Primary Care Patients.

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DESCRIPTION (provided by applicant): Significant numbers of older individuals experience cognitive decline with aging. The causes of cognitive dysfunction range from the devastating effects of Alzheimer's disease (AD) to normal mild forgetfulness described by most older individuals. However, the vast majority of cognitive dysfunction in older persons is related to potentially treatable disorders e.g. thyroid disease, renal disease or depression. Most older Americans receive their health care solely within the general practice setting but most primary care physicians (PCP) do not screen for cognitive difficulties. In our current R01 we conducted neuropsychological testing on 534 elderly PCP patients. Half of our study physicians received a cognitive report (CR) detailing the results of the patient's testing e.g. Normal, Mild Cognitive Impairment (MCI) or Impaired together with treatment recommendations and half did not receive a report. To date 377 patients have been retested at 2 years. Initial findings indicate that PCPs who receive a CR are more likely to order interventions, either medical (cognitive enhancing medications, specialist referrals, blood tests to rule out dementia) or non-medical (discussion of cognitive difficulties, in-home services); 21%(n=69) of CR patients received an intervention compared to 4.8%(n=16) of TAU patients. Patients in the CR group were less likely to visit an Emergency Room and had higher cognitive scores at 2-years. These are encouraging findings, however, they are based on traditional neuropsychological assessment and PCPs in general practice do not have access to these services. A second goal of the current R01 was to develop a brief computerized test to identify patients with MCI. We have shown that this test, known as the Computer Assessment of MCI (CAMCI), has a sensitivity of 86% and specificity of 94% for identifying MCI in the PCP patients when administered by research technicians. In the coming grant period we will conduct a randomized controlled trial (RCT) of the CAMCI in general practice to determine whether the same positive outcomes seen with traditional neuropsychological assessment are found with this screening instrument. Finally, results from our parent study confirm previous reports that MCI is an unstable diagnosis. We have a unique opportunity to follow MCI patients from the parent study to investigate factors associated with instability in the MCI diagnosis and also to determine if CAMCI can discriminate those who will eventually revert to normal cognitive status from those who do not (and are therefore are higher risk for a neurodegenerative process).The results of these studies will provide PCP's with the knowledge and ability to identify patients with potentially reversible causes of cognitive decline reducing the added burden of cognitive deficits; and also patients with very early AD, possibly slowing the progression of cognitive decline. PUBLIC HEALTH RELEVANCE: Effective management of older patients with Mild cognitive Impairment (MCI) and complex medical conditions is a challenge. Initial findings from our R01 suggest that physicians who are informed that their patient has MCI are more likely to order pharmacological and nonpharmacological interventions and patients have better outcomes. However, most physicians do not screen for MCI because they lack the tools and expertise. We will determine whether a brief Computer Assessment of MCI works as well as traditional neuropsychological testing. We will also investigate lifestyle and medical factors associated with instability in the MCI diagnosis.