A Cognitive Risk Calculator and Screening tool for Primary Care Settings

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PROJECT SUMMARY/ABSTRACT The number of people with Alzheimer’s disease is expected to exceed 88 million by 2050. Early detection of Alzheimer’s disease and related disorders symptoms are imperative for efforts to develop disease modifying therapies or interventions, and are important for optimal patient care. The objective of this proposal is to provide an accurate, feasible, and low-cost process to facilitate cognitive screening in population health. The aims of the R61 project are to develop and validate two complementary, automated tools to identify and screen patients at high risk for cognitive decline. The first is a risk calculator that uses routine clinical data to estimate patients’ risk for cognitive decline. Patients 60 years and older will undergo formal cognitive testing, and five prior years of routinely-collected electronic health record data will be used to model cognitive status. The Cognitive Risk Calculator will be validated in two historical samples and integrated into the electronic medical record to help providers identify vulnerable patients. The second tool is a validated iPad-based screening tool, the Brief Assessment of Cognitive Health (BACH) that patients can complete independently before, during, or after their doctor appointment. Patients will complete the BACH, the Montreal Cognitive Assessment Test (a paper-and-pencil screening tool), and formal neuropsychological testing at two time points. We hypothesize the BACH will be more sensitive to cognitive change over time than the established screening tool. The BACH is already integrated into the Epic electronic medical record platform; cognitive score and screening results for depression, stress, and sleep disruption are automatically recorded in the patient’s medical record for providers to document and act upon. The R33 project is a Phase IV pragmatic clinical trial to gauge the uptake and utility of these tools in primary care practices. Six internal medicine clinics will be randomized over time to the active study arm (Risk Calculator and BACH). This will permit comparisons of standard of care screening practices with screening activities following introduction of the Cognitive Risk Calculator and BACH. We will use a mixed-methods approach to determine optimal implementation strategies across a variety of practice models. Impact: The EHR risk-calculator and BACH have the capacity to improve detection of cognitive decline on a population health scale. The project also examines how regional differences in socioeconomic advantage relate to health disparities measured in terms of cognitive risk as well as screening attitudes and behaviors on the part of both providers and patients.