Nicole Fowler, PhD, discusses the various brief cognitive assessment tools that already exist, but says further research is needed to see if they work in minoritized populations.
One thing that is oftentimes overlooked in some of the public arena is that we actually do have very valid and brief tools that we can use in primary care to be able to identify people who might be at risk for Alzheimer’s disease and dementia. This could be a brief, five-minute test that does a pretty good job of differentiating who should go for further follow-up testing. I think the other piece is that what we’re finding actually is that some of the tools that we would traditionally use haven’t been tested actually in diverse populations. So while we do have tools, it’s very important that we’re starting to use these in more diverse populations to find out if it really is identifying people who look different than those who they were tested on.
Dr. Fowler says primary care providers face a dilemma — they may be able to detect early signs of dementia, but they don’t necessarily have longitudinal care to recommend.
Once you detect somebody who may be at risk for dementia, that really is just the very first step of then determining do they actually need further follow-up testing. And then if they do, how do we provide longitudinal care to them and their family? And that’s the piece, I think, that is really, really hard to talk about early detection, because without that longitudinal care, lots of providers are going to feel like, “I just don’t have the ability to care for these people if it is determined that they have dementia.” And that’s really been the biggest barrier, because we don’t have a healthcare system, especially rooted in primary care, that is set up to be able to do this sort of longitudinal care that patients with dementia and their families need.
Dr. Fowler says primary care is poised to prevent negative cognitive outcomes.
A lot of the things that we know that could improve people’s brain health outcomes start in primary care. For example, sleep apnea. A lot of untreated sleep apnea can produce cognitive impairment, and that if treated, could really kind of stabilize somebody’s cognition. And that is a preventive measure that starts with the identification of that in primary care.