Dementia is a critical issue affecting more than six million older adults in the United States, and the impact on Black and Hispanic communities is particularly severe. Despite its prevalence, cognitive impairments often go unnoticed by healthcare providers, especially in busy primary care settings. Early diagnosis of dementia or mild cognitive impairment (MCI) is crucial for effective treatment and planning, helping to keep older adults safe. However, traditional cognitive tests can be lengthy, expensive, and culturally biased.
The Challenge of Early Detection
In many primary care settings, signs of cognitive impairment are frequently missed, leaving many older adults without the necessary care and support. This issue is even more pronounced among Black and Hispanic populations due to cultural biases in existing cognitive tests and the demanding nature of primary care environments.
To address these disparities, a research team led by Dr. Joe Verghese at the Albert Einstein College of Medicine developed a new cognitive assessment tool called 5-Cog. This innovative tool is designed to be culturally unbiased and can be used by non-healthcare professionals, making it accessible and practical for diverse primary care settings.
How 5-Cog Works
The 5-Cog tool consists of three brief tests that assess:
- Memory Recall: Evaluating the ability to remember and recall information.
- Cognition and Gait Connection: Observing how cognitive function affects walking and movement.
- Symbol-to-Picture Matching: Testing the ability to associate symbols with corresponding images.
The entire process takes about five minutes, and if the results indicate cognitive problems, the tool automatically updates the patient’s electronic health record. This triggers a set of recommendations to be sent to their healthcare provider, ensuring timely follow-up and intervention.
In a study funded by the National Institutes of Health (NIH), the 5-Cog tool was tested with approximately 1,200 older adults from disadvantaged neighborhoods in Bronx County, New York City. The study population was predominantly Black, Hispanic, or Latino, with a significant portion having low educational attainment. Participants were randomly assigned to take either the 5-Cog test or an unrelated physical test (control group) before their primary care visit.
The results, published in Nature Medicine on June 4, 2024, were promising:
- Improved Dementia Care: Nearly 20% of those who took the 5-Cog test received enhanced overall dementia care, compared to just under 7% in the control group.
- New Diagnoses and Referrals: Participants who took the 5-Cog test showed significant improvements in receiving new diagnoses of dementia or MCI, further assessments, and specialist referrals within 90 days of the test.
The significance of the 5-Cog tool extends beyond its immediate results. Early detection of dementia allows for better management of the disease, including:
- Timely Interventions: Identifying dementia early enables healthcare providers to implement treatments that can slow the progression of the disease, improving the quality of life for patients.
- Care Planning: Early diagnosis helps families and caregivers plan for the future, ensuring that appropriate support systems are in place.
- Reducing Healthcare Disparities: Tools like 5-Cog that are designed with cultural sensitivity in mind help bridge the gap in healthcare disparities, providing equitable care for all populations.
The success of the 5-Cog tool in this study suggests it could transform primary care practices, enabling more older adults to receive timely diagnoses and treatment for cognitive impairments. Further research is ongoing, including a clinical trial to evaluate the tool’s effectiveness in identifying early cognitive changes in older adults who do not report any cognitive concerns. Additionally, the tool will be tested in different populations to ensure its broad applicability and effectiveness.
How You Can Advocate for Better Dementia Care
As a member of the Black community, it is crucial to advocate for the adoption of tools like 5-Cog in your local healthcare settings. Here are some steps you can take:
- Stay Informed: Keep up-to-date with the latest research and advancements in dementia care.
- Ask Questions: During healthcare visits, inquire about the availability of cognitive assessments and advocate for the use of culturally unbiased tools.
- Spread Awareness: Educate family members, friends, and community groups about the importance of early detection and the benefits of tools like 5-Cog.
- Support Policy Changes: Encourage local and national policymakers to prioritize funding and implementation of effective cognitive assessment tools in primary care settings.
