One of the initial studies examining how common unrecognized cognitive impairment is among patients at Federally Qualified Health Centers has revealed that this issue is widespread, especially among older adults from minoritized groups. These centers offer primary care and preventive services to over 30 million patients, irrespective of their ability to pay or whether they have health insurance, including an increasing number of elderly individuals.
One of the initial studies examining how common unrecognized cognitive impairment is among patients at Federally Qualified Health Centers has revealed that this issue is widespread, especially among older adults from minoritized groups. These centers offer primary care and preventive services to over 30 million patients, irrespective of their ability to pay or whether they have health insurance, including an increasing number of elderly individuals.
Identifying cognitive impairment early and fairly can provide significant advantages to patients and their families. If diagnosis is delayed, it can lead to poor health outcomes for both patients and their caregivers and restrict access to essential treatment and care management services.
The study focused on 204 older adults who are socially and economically vulnerable, with an average age of 70 years. The findings indicated that African American participants were more than twice as likely to have unrecognized cognitive impairment, which includes mild cognitive impairment or dementia.
Approximately 82% of Black participants were found to have undiagnosed conditions related to dementia or mild cognitive impairment, compared to 64% of White participants. A mere 26% of all participants exhibited no cognitive impairment.
The study group was composed of slightly more than half African American individuals and primarily women. The relationship between race and cognitive impairment was consistent across different ages, sexes, and levels of education.
On average, each participant was receiving primary care for three chronic medical issues, such as diabetes, heart disease, high blood pressure, or chronic obstructive pulmonary disease, and they were on five different medications.
To confirm diagnoses, the researchers conducted interviews with patients and their families, examined three years’ worth of medical records, and administered complete cognitive testing alongside neurological examinations.
“Our previous research indicates that there is stigma associated with cognitive impairment diagnoses, as well as anxiety about losing independence. Consequently, patients and their caregivers might hesitate to request that their primary care providers assess their brain health,” explained Dr. Malaz Boustani, the lead author of the study. “To ensure high-quality care and mitigate disparities alongside stigma, we need to create scalable, timely, equitable, and sustainable methods for the early detection of cognitive impairment in primary care settings, particularly within Federally Qualified Health Centers, which serve mainly low-income and medically underserved populations.”
“By detecting issues early, patients and their caregivers could access three recent advancements in brain health. The first is amyloid-lowering therapy, which has the potential to alter the decline of cognitive and functional abilities in Alzheimer’s disease patients. The second is a new payment model from the Centers for Medicare and Medicaid Services (CMS) designed to help cover the costs associated with comprehensive dementia care, including support for caregivers.”
“Lastly, early detection paves the way for reducing future cognitive impairment risks through lifestyle changes that target blood pressure, diabetes, cholesterol, sleep, and depression. It also promotes cognitive and physical exercises.”
Utilizing machine learning techniques, Dr. Boustani and his team have created and are testing an affordable, scalable method for identifying cognitive impairment based on information recorded in patients’ electronic health records. They refer to it as a “zero minute assessment,” costing less than one dollar, and aim to establish it as a culturally sensitive solution—a redesign of the healthcare system to address a problem that it currently lacks the time and financial resources to resolve.
The authors of the study note, “The variances in diagnoses across different races may stem from both a higher prevalence of dementia in these groups and an absence of processes that enable detection and timely diagnosis among these individuals, influenced by various patient, physician, and healthcare system factors that require immediate attention.”
“Prevalence of Unrecognized Cognitive Impairment in Federally Qualified Health Centers” is published in JAMA Network Open. The research was funded by the National Institutes of Health’s National Institute on Aging through grant R01AG069765, with Principal Investigators Malaz Boustani, Zina Ben Miled, and James Galvin.
In addition to Dr. Boustani, the study authors from the Regenstrief Institute include Research Scientist Nicole Fowler, PhD, MHSA, Arthur Owora, PhD, MPH, and Affiliate Scientist Zina Ben Miled, PhD.
