Early detection of cognitive impairment in adults is important in planning care for Alzheimer’s Disease and related dementias. Research has shown this impairment can begin in the brain well before outward symptoms appear in everyday life. Cognigram, a digital cognitive assessment system, can identify subtle changes in cognition over time, and is used in hundreds of research studies around the world.
Computerized assessment of cognition has the potential to be leveraged in mainstream primary care settings to efficiently and accurately test millions of adults over the age of 40. However, the busy, noisy surroundings of a primary care clinic are much different than the quiet, controlled environment of a research center. And while volunteers of a research program are carefully selected and screened, a clinic is visited by a diverse and random set of patients each day, especially in an urban setting. Any computerized assessment of cognition needs to be easy to understand, especially for adults with minimal computer experience, and able to be administered with limited staff involvement.
For this reason, a recent study, published in Alzheimer’s & Dementia, evaluated the use of Cognigram in the waiting rooms of the emergency, family medicine and geriatric psychiatry departments of University Hospital State University of New York Downstate in Brooklyn, New York. The aim of the study was not to analyze individual results from the Cognigram assessment but rather the attitudes and acceptance of the patients towards computerized cognitive assessment in a primary care setting.
Targeting a busy clinic in the heart of Brooklyn was intentional. This borough is one of the most ethnically diverse and densely populated communities in the world. In addition, Brooklyn residents have a proportionally high risk of vascular disease, which may contribute to cognitive impairment and dementia-related diseases.
Cognigram broadly assesses four cognitive domains, psychomotor function, attention, learning, and working memory, and is valid for ages 6 to 99. The computerized assessment is ideal for a diverse population, like in Brooklyn, as it is unaffected by language, education or ethnic culture.
Starting in the Emergency Department, medical students or social workers approached patients in the waiting room. The students asked if the patient would complete a computerized set of tests while they waited. As might be expected, the ED patients were less willing to cooperate as they were distracted with their need to see a doctor.
Next, the testing team moved to the family medicine department, where they took a different approach:
We always mentioned that (1) our primary goal was to improve the quality of clinical care (their interest was heightened if we mentioned that local care quality would be improved), (2) hospitals across the country were using similar technologies, (3) the government had approved its use, (4) Cognigram results would not be attached to their name or personal health information, (5) Cognigram results would not be seen by a clinician, and (6) patients would not lose their place in the queue and could leave as soon as they were called.”
With the improved introduction, the patients in Family Medicine were more receptive to taking the test, which they could do on a laptop wheeled up to where they sat. Despite the noise of the waiting room TVs and the general activity of a busy environment, patients were able to complete Cognigram tests as well as a short survey asking for their ratings of the experience.
Moving to the geriatric psychiatry department, the staff and patients were very receptive to Cognigram, with the researchers noting, “many participants expressed the desire to have their friends and family members complete the Cognigram in the clinic at a future date.”
Overall, the patients at the Brooklyn clinic rated Cognigram favorably.
- 58 adults completing the entire assessment at an average age of 68, and over two-thirds gave the experience a positive rating of 4 or 5 on a 5-point scale
- 95% of patients reported the test instructions were easy to understand
- 91% said they liked completing the test while they waited for their appointment
- 97% said they would be willing to take the test again at their clinic in the next year
The study authors were pleased with the results and took away several key learning points:
“The goal of the pilot study was the implementation of Cognigram in nontraditional settings and without directive from a healthcare provider. This approach reflects movements in the U.S. to explore patient risk and early detection assessments that can be accomplished in waiting rooms to reduce physician and healthcare provider burden and cost…Our pilot study of a computerized cognitive performance assessment showed that implementation in diverse, health disparities PCS must be both ‘fit for purpose’ and ‘fit for community.’ Our investigative team learned an exemplary amount that will fuel better public health and health-care for our community.”
To learn more about Cognigram, please check out this website, or watch the video below.