Dementia Care Research and Psychosocial Factors

Area of Science:

• Geriatrics
• Primary Care Medicine
• Neuroscience

Background:

• Early detection of cognitive impairment (CI) in primary care is crucial but challenging.
• Primary care physicians (PCPs) face time constraints and expertise gaps in managing brain health.
• Scalable and sustainable diagnostic pathways are needed to improve CI detection.

Purpose of the Study:

• To adapt and implement evidence-informed diagnostic care pathways for earlier CI detection in primary care.
• To engage stakeholders, including front-line clinicians and leaders, in preparing for a pragmatic trial.
• To integrate provider education, digital cognitive assessment tools, and registered nurse (RN) support into primary care.

Main Methods:

• Stakeholder engagement meetings were conducted with primary care clinics.
• Thematic analysis of meeting transcripts guided intervention adaptations.
• A care pathway involving the TabCAT-Brain Health Assessment (BHA) tool and RN support was developed and implemented.

Main Results:

• The implemented pathway involves RNs assessing patients, triangulating data, and supporting PCPs in diagnosis and care planning.
• Since March 2024, 740 TabCAT-BHAs were completed, with 80% of patients classified with mild or major neurocognitive disorder.
• 85% of PCPs reported high likelihood of recommending the TabCAT-BHA care pathway to peers.

Conclusions:

• PCPs desire to provide optimal brain health care within existing constraints.
• Tailored practice supports are essential for high acceptability and sustainability of new care pathways.
• The integrated RN-led support model shows promise for improving CI detection and management in primary care.