Key Takeaways

A new five-minute test could makescreening for cognitive declinemuch easier for primary care providers (PCPs).

The test, which can be embedded into an electronic medical record (EMR), may help providers determine if more tests or referrals are needed for patients who are showing signs of cognitive impairment. This step could be crucial for closing the gap in the underdiagnosis ofdementia, especially in lower-income populations.

The researchers studied the 5-Cog paradigm test with more than 1,000 older adults living in socially disadvantaged neighborhoods in the Bronx, New York. The adults were all at least 65 years old, and 94% were Black, Hispanic, or Latino. All the patients had expressed cognitive concerns during a visit with a primary care provider.

“Cognitive impairment is common and a growing problem in older populations in the U.S. and elsewhere,”Joe Verghese. MBBS, the study’s senior author and a professor and director of the Saul R. Korey Department of Neurology at Albert Einstein College of Medicine, told Verywell. “Yet over half of dementia cases are not diagnosed in primary care, which is at the frontline of this epidemic.”

Given those numbers, Verghese said that “there is a great need to improve how older individuals with cognitive concerns are detected and managed in primary care” and that “this the impetus to develop the 5-Cog paradigm.”

How the 5-Minute Dementia Test Works

The three screenings that make up the 5-Cog paradigm test are:

If a patient scores positive on any of thetests, they are flagged in the EMR for provider follow-up. Providers are also given access to a decision tree that outlines what could come next for patients, which could include:

“Unlike many cognitive screening tests, the 5-Cog accounts for cultural differences as well as low education,” said Verghese. “While there are many other cognitive screening tests, most do not provide guidance to primary care physicians on the next steps following normal or abnormal test results.”

Will Your PCP Screen You for Dementia?

According to a survey from the University of California, San Francisco, only 20% of primary care providers felt confident interpreting cognitive test results, and only 21% felt confident that they correctly recognized when a patient had a neurocognitive disorder.

A simplified cognitive test, such as the 5-Cog paradigm embedded into an EMR that comes with a decision tree, could help providers feel more confident about taking action steps with older patients who have concerns about cognitive impairment.

“Primary care is the right place to start in regards to cognitive impairment screening,”Victor Henderson, MD, professor of epidemiology and population health, and neurology at Stanford Health Care, told Verywell. “While it doesn’t mean they will come up with the same answer as a specialist, they are positioned to make an initial evaluation and a suspected diagnosis. It is the best first step, regardless of what insurance you have.”

The 13 Forms of Dementia

Do You Need a Dementia Screening?

Routine screening for cognitive impairment is not recommended at a certain age, so it is important to let your provider know if you are having any symptoms. They’ll be able toadminister a screening test(like the 5-Cog paradigm) and help guide you about the next steps in diagnosis and treatment, like getting a referral to a specialist.

Everyone should know the10 warning signs of Alzheimer’s. That way, you may be better able to recognize them in yourself or a loved one:

If you’re worried about developing cognitive impairment in your later years, know that some mildcognitive changes as you get olderare normal—things like subtledeclinesin memory, thinking, and reasoning. The key is that these changes should not affect your quality of life or core personality.

If you or a family think that what’s going on is more than typical signs of aging, make an appointment with your primary care provider to discuss the symptoms.

What This Means For YouIf you or a loved one is showing signs of dementia or cognitive decline that is starting to affect daily living and quality of life, make an appointment with a primary care provider. They can use tools to screen for dementia symptoms and make a plan for care and treatment.

What This Means For You

If you or a loved one is showing signs of dementia or cognitive decline that is starting to affect daily living and quality of life, make an appointment with a primary care provider. They can use tools to screen for dementia symptoms and make a plan for care and treatment.

Life Expectancy of Patients With Alzheimer’s Disease and Dementia

8 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Verghese J, Chalmer R, Stimmel M, et al.Non-literacy biased, culturally fair cognitive detection tool in primary care patients with cognitive concerns: a randomized controlled trial.Nat Med. Published online June 4, 2024. doi:10.1038/s41591-024-03012-8

Chalmer R, Ayers E, Weiss EF, et al.The 5-Cog paradigm to improve detection of cognitive impairment and dementia: clinical trial protocol.Neurodegener Dis Manag. 2022;12(4):171-184. doi:10.2217/nmt-2021-0043

Albert Einstein College of Medicine.5-minute test leads to better care for people with dementia in the primary care setting.

US Preventive Services Task Force, Owens DK, Davidson KW, et al.Screening for cognitive impairment in older adults: US Preventive Services Task Force recommendation statement.JAMA. 2020;323(8):757-763. doi:10.1001/jama.2020.0435

Bernstein A, Rogers KM, Possin KL, et al.Dementia assessment and management in primary care settings: a survey of current provider practices in the United States.BMC Health Serv Res. 2019;19(1):919. doi:10.1186/s12913-019-4603-2

Siddiqui M, Nyahoda T, Traber C, et al.Screening for cognitive impairment in primary care: rationale and tools.Mo Med. 2023;120(6):431-439.

Centers for Disease Control and Prevention.10 warning signs of Alzheimer’s.

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