Effective identification of cognitive impairment in primary care assisted by tablet-based digital cognitive testing

Background Timely recognition of cognitive impairment and Alzheimer's disease (AD) is crucial for providing appropriate care to elderly individuals affected by these conditions. Digital short tests may help general practitioners (GPs) make more targeted referrals to specialists. Objective We studied the real-world effectiveness of a referral pathway including the digital Montreal Cognitive Assessment (MoCA Duo), administered by medical assistants (MAs) in general practitioner (GP) offices, to identify mild or major neurocognitive impairment. Ancillary studies examined the procedure's feasibility, usability, and barriers in the care pathway. Methods Ten GPs participated, one or two MAs per practice administered the MoCA Duo to patients with cognitive concerns. Patients with likely or questionable impairment were offered a referral to a memory clinic (MC) if deemed clinically appropriate. At the MC, patients received a comprehensive neuropsychological examination and a geriatric assessment. Results Of the 299 patients tested in GP practices (mean age: 73; 65% female), 100 achieved MoCA Duo scores in the presumably unimpaired range. 93 patients (46.73%) scoring below 27 points were referred to the MC; of those, 66 attended an appointment. 40 patients had major cognitive impairment, including 9 diagnosed with AD or vascular dementia, and 15 had mild cognitive impairment (MCI). 83.33% of patients who screened positive on the MoCA Duo at the GP practice and were assessed at the MC had at least MCI. Conclusions Digital tests administered by MAs can help to effectively screen for cognitive impairment in primary care, supporting targeted referrals of patients with likely cognitive impairment.