A new five-minute, culturally neutral cognitive assessment tool called 5-Cog has demonstrated success in enhancing dementia detection and management among older adults, according to a study led by Dr. Joe Verghese from the Albert Einstein College of Medicine. The tool offers potential benefits for increasing access to dementia care, particularly in disadvantaged areas across the United States.

Dementia affects over 6 million older adults in the country. However, healthcare providers often miss signs of cognitive impairment, especially among older Black and Hispanic Americans, due to busy primary care settings. Early diagnosis of dementia or mild cognitive impairment is crucial for effective treatment and planning to ensure the safety of older adults in their living environments.

Standard tests for dementia can be time-consuming, expensive, and typically require trained clinicians to administer. Furthermore, cultural biases within these tests may hinder their effectiveness in more diverse populations. To address these challenges, Dr. Verghese's research team developed the culturally unbiased cognitive assessment tool, 5-Cog, specifically designed for older adults with concerns about their cognitive health.

The 5-Cog tool comprises three brief tests: memory recall, the relationship between cognition and gait, and matching symbols to pictures. If cognitive problems are indicated, the tool automatically generates a notification in the patient's electronic health record, prompting a set of recommendations for their healthcare provider. The entire process takes approximately five minutes and can be administered by individuals without healthcare expertise.

In a study funded by the National Institutes of Health (NIH), the researchers tested 5-Cog among 1,200 older adults from a primary care clinic in Bronx County, New York City. All participants lived in disadvantaged neighborhoods, with nearly three-quarters being women. Approximately 94% identified as Black, Hispanic, or Latino, and 40% had not completed high school.

The participants were randomly assigned to either receive the 5-Cog test or an unrelated physical test as the control group, just before their primary care visits. The findings, published on June 4, 2024, in Nature Medicine, revealed that almost 20% of the older adults who took the 5-Cog test experienced improved overall dementia care, compared to just under 7% in the control group. Additionally, those who underwent the 5-Cog test showed significant improvements in various aspects of dementia care, including new diagnoses of dementia or mild cognitive impairment, further assessments, and specialist referrals within 90 days of assessment.

Dr. Verghese expresses optimism that these study findings could drive changes in primary care practice, ensuring that more older adults with mild cognitive impairment or dementia benefit from timely diagnosis and treatment.

Further research is currently underway, including a clinical trial to assess the effectiveness of 5-Cog in identifying early cognitive changes among older adults who do not report any cognitive concerns. Additionally, the tool will undergo testing in different populations to evaluate its broader applicability.

The development of a brief, culturally neutral cognitive assessment tool like 5-Cog offers promising potential in improving dementia detection and management, offering hope for increased access to care for older adults across diverse communities in the United States.