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Cognitive Impairment Toolkit Helps Providers With Detection, Earlier Diagnosis

The Gerontological Society of America (GSA) is now offering a free online toolkit to aid primary care providers in achieving greater awareness of cognition in their older adult patients, increasing cognitive detection of cognitive impairment, securing earlier diagnostic evaluation, and referring to community services.

The GSA-developed toolkit is focused on the KAER model, first introduced in a 2015 report from the Society's Workgroup on Cognitive Impairment Detection and Earlier Diagnosis. The acronym is derived from a four-step process:

• Kickstart the cognition conversation
• Assess for cognitive impairment
• Evaluate for dementia
• Refer for community resources

"This toolkit is a valuable resource because it brings together in one place an extensive amount of existing evidence-based, practical, and easy-to-use guidance to the busy primary care provider about how to work with older adults and their families who are concerned about brain health and cognitive decline," says Richard Fortinsky, PhD, FGSA, chair of the GSA workgroup. "To our knowledge, there is no other such comprehensive and evidence-based toolkit available to clinicians and health systems."

Fortinsky says the GSA Workgroup developed the KAER model with the goal of greatly increasing communication between older adults, their families, and primary care providers about the importance of preserving brain health and addressing concerns about memory loss and other symptoms of cognitive decline. 

Workgroup member and GSA visiting scholar Katie Maslow, MSW, oversaw the development of the toolkit with review and input from the other members. In general, the tools they chose to include can be adapted by primary care providers, health plans, and health care systems to fit their existing primary care structure, organization, and procedures.

"We have tried to offer assessment tools and materials primary care providers can share with their patients in an easily accessible format," Maslow says. "Another advantage of the toolkit is that it provides rationales for the four steps and choices of tools and materials so that primary care physicians can select what will work best for them."

Available data show that cognitive impairment is severely under-detected in the U.S. On average, only about half of people with dementia have a diagnosis of the condition in their medical record, according to Maslow, who added that the proportion varies a lot among practice settings.

"We also provided a choice of tools whenever possible," Maslow says. "One reason for that is that some primary care providers may already be using a tool for a particular purpose; for example, a brief cognitive assessment instrument. Another reason is that primary care providers practice in a wide array of settings, including single-provider offices, physician group practices, and large, multi-provider healthcare systems. Particular tools may fit better with particular primary care practice settings."

Contents of the toolkit include tips for communicating with older adults about brain health; actual clinically-relevant and scientifically supported measurement instruments for detecting cognitive impairment; links to clinical practice guidelines for conducting diagnostic evaluations for dementia; and comprehensive listings of community resources that are available to help older adults and families living with the daily challenges of cognitive impairment and diagnosed dementia.

 "The toolkit's release coincides with numerous other initiatives at state and federal levels to raise public awareness about the importance of considering the health of the brain in the same way that the health of all other parts of the body are essential to consider to optimize well-being and quality of life as we all age," Fortinsky says.

Among such initiatives: increased monitoring of the uptake of the Medicare Annual Wellness Visit by the Centers for Medicare and Medicaid Services, which includes the requirement that cognitive impairment be assessed; the focused involvement of the Centers for Disease Control and Prevention on promotion of brain health and raised awareness of mid and later life risk factors associated with development of cognitive impairment; and development of milestones to address the numerous goals and objectives regarding care and support services in the National Alzheimer's Plan Act, which include improved detection, diagnosis, and management of cognitive impairment, and diagnosed Alzheimer's disease and other types of dementia.

"Knowing that most older adults have a primary care physician and often visit them several times per year, we directed the KAER process to that primary audience to raise their awareness of the need to begin discussing the importance of brain health for all older patients—even those with no symptoms or concerns about memory problems or other cognitive changes," Fortinsky says. "And assessing cognitive symptoms using evidence-based assessment tools, evaluating those older adults with clearly significant symptoms to arrive at a careful diagnosis, and referring these patients and their families to the rapidly growing number of dementia-capable services in the community—all are part of this process where primary care physicians could greatly help these patients and families."

Source: Gerontological Society of America