5-minute test leads to better care for people with dementia in the primary care setting

June 4, 2024—(BRONX, NY)—The underdiagnosis of dementia, especially among Black and Hispanic patients, is a long-standing challenge in medicine. A new study, published today in Nature Medicine, finds that an easy, five-minute assessment paired with recommendations built into the electronic medical record system led to a three-fold improvement in diagnosis and treatment for patients in a primary care setting compared to a control group. The “5-Cog paradigm,” which was developed by researchers at Albert Einstein College of Medicine and Montefiore Health System, dramatically enhances the diagnosis of mild cognitive impairment and dementia, and represents a new, better way to guide initial treatment.

“Dementia is often undiagnosed in primary care—and even when diagnosed, it often goes untreated,” said Joe Verghese, M.B.B.S., the paper’s senior author and developer of the 5-Cog paradigm. “Until now, most approaches to detecting cognitive impairment take a long time, are expensive, and require a neurologist. And since existing tests were developed in white populations, they don’t account for cultural differences. We’ve tried to address these inadequacies with current tests, and the findings from our study show meaningful progress on all fronts.”

Dr. Verghese is professor and director of the division of cognitive and motor aging in the Saul R. Korey Department of Neurology, the Judith and Burton P. Resnick Chair in Alzheimer’s Disease Research, the Murray D. Gross Memorial Faculty Scholar in Gerontology, and director of the Jack and Pearl Resnick Gerontology Center at Einstein and director of the Montefiore Einstein Center for the Aging Brain. Emmeline Ayers, M.P.H., a principal staff scientist in the department of neurology, is last author on the paper.

Dr. Verghese’s 5-Cog assessment involves a picture-based memory-impairment screening test, a short picture-based symbol match, and confirmation that a patient has cognitive complaints. Previous research has found that the image-based assessment effectively addresses testing disparities resulting from a person’s preferred language, education level, and gender. Importantly, the assessment can be given by minimally trained non-physician personnel who can convey results to a primary care provider. The cognitive assessment is paired with recommendations to guide primary care physicians on next steps, including referral to a specialist.

The study involved 1,201 older Bronx-residing primary care patients (median age 72.8) with cognitive concerns. Ninety-four percent of patients were Black and/or Hispanic/Latino and all of them resided in zip codes designated as socioeconomically disadvantaged neighborhoods. The patients were randomly assigned either to the group receiving the 5-Cog approach (599 patients) or to a control group that was not tested. Follow-up over the next 90 days showed that, compared with the control group, those patients who had undergone 5-Cog paradigm were three times likelier to have benefited from “improved dementia care actions,” including being diagnosed for new mild cognitive impairment or dementia, being referred to specialists, and receiving medications.

“We’re hopeful that the findings from this study could promote changes in primary care practice so that more older people with mild cognitive impairment or dementia will benefit from getting diagnosed and treated for their conditions,” Dr. Verghese said.

The Nature Medicine article is titled “Non-Literacy Biased, Culturally Fair Cognitive Detection Tool in Primary Care Patients with Cognitive Concerns: A Randomized Controlled Trial.” In addition to Dr. Verghese and Ms. Ayers, the other Montefiore Einstein authors on the study are Rachel Chalmer, M.D., Marnina Stimmel, Ph.D., Erica Weiss, Ph.D., Jessica Zwerling, M.D., M.S., Rubina Malik, M.D., David Rasekh, B.S., Asif Ansari, M.D., Amy R. Ehrlich, M.D., and Cuiling Wang, Ph.D., as well as Roderick A. Corriveau, Ph.D., of the National Institutes of Health. The research was supported by grants from the National Institute of Neurological Disorders and Stroke and the National Institute on Aging (UG3NS105565 and U01NS105565). Albert Einstein College of Medicine has copyright protection related to this cognitive test. Interested parties can contact the office of biotechnology and business development at [email protected].

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About Albert Einstein College of Medicine
Albert Einstein College of Medicine is one of the nation’s premier centers for research, medical education and clinical investigation. During the 2023-24 academic year, Einstein is home to 737 M.D. students, 209 Ph.D. students, 124 students in the combined M.D./Ph.D. program, and approximately 239 postdoctoral research fellows. The College of Medicine has more than 2,000 full-time faculty members located on the main campus and at its clinical affiliates. In 2023, Einstein received more than $192 million in awards from the National Institutes of Health. This includes the funding of major research centers at Einstein in cancer, aging, intellectual development disorders, diabetes, clinical and translational research, liver disease, and AIDS. Other areas where the College of Medicine is concentrating its efforts include developmental brain research, neuroscience, cardiac disease, and initiatives to reduce and eliminate ethnic and racial health disparities. Its partnership with Montefiore, the University Hospital and academic medical center for Einstein, advances clinical and translational research to accelerate the pace at which new discoveries become the treatments and therapies that benefit patients. For more information, please visit einsteinmed.edu, follow us on Twitter, Facebook, Instagram, LinkedIn, and view us on YouTube. 

About Montefiore Health System
Montefiore Health System is one of New York’s premier academic health systems and is a recognized leader in providing exceptional quality and personalized, accountable care to approximately three million people in communities across the Bronx, Westchester and the Hudson Valley. It is comprised of 10 hospitals, including the Children’s Hospital at Montefiore, Burke Rehabilitation Hospital and more than 200 outpatient ambulatory care sites. The advanced clinical and translational research at its medical school, Albert Einstein College of Medicine, directly informs patient care and improves outcomes. From the Montefiore-Einstein Centers of Excellence in cancer, cardiology and vascular care, pediatrics, and transplantation, to its preeminent school-based health program, Montefiore is a fully integrated healthcare delivery system providing coordinated, comprehensive care to patients and their families. For more information, please visit www.montefiore.org. Follow us on Twitter and Instagram and LinkedIn, or view us on Facebook and YouTube.