Cognitive testing in older primary care patients: A cluster-randomized trial

Area of Science:

• Gerontology
• Primary Care Medicine
• Neurology

Background:

• Cognitive impairment (CI) is a growing concern in primary care settings.
• Early detection and intervention are crucial for managing CI.
• The impact of routine neuropsychological testing on physician behavior and CI progression is not well understood.

Purpose of the Study:

• To determine if neuropsychological testing in primary care (PC) offices influences physician-initiated interventions for cognitive impairment (CI).
• To assess if such testing impacts the rate of CI progression.
• To evaluate the effectiveness of cognitive reports (CR) in a PC setting.

Main Methods:

• A 24-month, cluster-randomized study involving 11 community-based PC practices.
• Practices were randomized to either treatment as usual or cognitive report (CR) arms.
• 533 patients aged ≥65 without CI diagnosis were recruited; 423 were retested at 24 months.

Main Results:

• Physicians in the CR arm were significantly more likely to order cognitive-related interventions (P = .02).
• CR physicians more frequently documented cognition discussions (P = .003) and ordered tests for reversible CI (P = .002).
• CR patients showed higher rates of cognitive medication prescriptions at follow-up (P = .02), with no difference in cognitive decline rate.

Conclusions:

• Providing cognitive information to physicians significantly increases physician-initiated interventions for patients with CI.
• Routine cognitive testing in PC does not appear to alter the rate of cognitive decline.
• Cognitive reports can enhance physician engagement with cognitive health in primary care settings.