Dementia - Screening and Diagnosis of Early Cognitive Impairment

This study was conducted between October 1, 2007 through September 2008 and was funded by a grant from Extendicare Foundation (Milwaukee, WI). In this random-controlled trial we tested two screening tools, Blessed Orientation-Memory-Concentration test (BOMC) & Clock Drawing Test (CDT), to determine realistic ways to diagnose Early Cognitive Impairment (ECI). We wanted to demonstrate the practicality of integrating a two-stage testing process to identify patients with ECI into the daily practices of family physicians and other primary care providers.

Four objectives were addressed in this study:

1. To determine whether family physicians and their office staff prefer using the Blessed Orientation-Memory-Concentration test (BOMC) or the Clock Drawing Test (CDT) as an instrument to screen their older patients for early cognitive impairment (ECI);
2. To evaluate family physicians' willingness to implement routine screening of their older patients for ECI in their daily practice;
3. To determine whether family physicians are willing to follow-up with patients who test positive on the initial screen (based on results from either BOMC or CDT) by having them return for diagnostic testing; and
4. To assess patients' responses to general screening and willingness of patients who have a positive screen for ECI to return for a subsequent appointment for diagnostic testing using the MCIS test.

Key Findings

Based on the study results, we can say that if screening and diagnostic testing for ECI/dementia as demonstrated in this project is going to be implemented in primary care offices, there must be:

• ways to implement this process without disrupting ordinary practice flow, including alternatives for its implementation that can be shown to work;
• reimbursable to the extent to which it will be worth the effort financially for the practice to implement systematically; and
• (Probably most importantly) effective treatments for ECI and dementia or demonstration of other benefits from early recognition of the problem.

Quality measures and clinical tools can bring focus and clarity to caring for patients with cognitive impairment and supporting their caregivers. Brian K. Unwin, MD, FAAFP, AGSF, CMD, Natalia Loskutova, MD, PHD, Patrick Knicely, BA, and Christopher D. Wood, DO. Fam Pract Manag. 2019 Jan-Feb;26(1):11-16.