Digital cognitive assessments may offer a feasible way to screen older adults for dementia

Background and goal: Many adults aged 65 and older never receive a cognitive check during regular primary care visits. This study assessed the feasibility and acceptability of implementing a digital cognitive assessment for Alzheimer disease and related dementias (ADRD) screening into primary care. 

Study approach: From June 2022 to May 2023, seven Indiana University Health clinics offered the five-minute Digital Clock & Recall test on an iPad to every patient 65 and older. Each site set its own rules on which visit types and which staffers would run the screen and upload results to the electronic record for the physician to review. In month three, researchers introduced a registered-nurse role to support patients for completing care pathways if they were flagged for cognitive impairment. Physicians retained discretion over follow-up.

Main results

• Of the 16,708 patients identified as eligible for screening, a total of 1,808 digital cognitive assessments (10.8%) were completed by 1,722 unique patients.

• More than one-half (55.3%) of eligible visits never offered the digital cognitive assessment because PCPs declined or the encounter was deemed out of scope. 

• Screening outcomes: Among 1,808 tests, 44.3% were categorized as unimpaired, 36.5% as borderline, and 13.7% as impaired.

• During follow-up within 90 days for the impaired group, 2.1% received a new Alzheimer or related-dementia diagnosis. Additionally, 5.1% received a new mild cognitive impairment diagnosis, 16.9% had brain imaging ordered, and 62.7% were referred to the brain health navigator.

Why it matters: Digital cognitive assessments may offer a feasible way to screen older adults during routine visits, helping identify those who may benefit from early diagnosis, treatment, and care planning.