The Gerontological Society of America has developed a free online toolkit to help primary-care doctors detect and diagnose cognitive impairment, dementia and Alzheimer’s disease, the most common type of dementia.
The toolkit is based on a four-step process for detecting cognitive impairment and diagnosing dementia earlier. The society named the model KAER, for Kickstart the cognition conversation, Assess for cognitive impairment, Evaluate for dementia, and Refer for community resources. The organization’s Workgroup on Cognitive Impairment Detection and Earlier Diagnosis came up with the model in 2015.
Step one, Kickstart, involves primary-care physicians starting a conversation with patients and their families about memory loss and other signs that patients may be developing dementia.
In the second step, Assess, doctors use cognitive impairment detection tools to assess whether a patient has dementia. The Gerontological Society says a tool should have four characteristics: It should be able to be administered in less than five minutes; it should assess memory and at least one other cognitive domain; medical staff should be able to administer it easily; and it should be free from cultural and language bias.
Step three, Evaluate, involves doctors thoroughly evaluating patients who show signs of cognitive impairment, and doing a full diagnostic workup.
The fourth step, Refer, involves getting Medicare recipients who are diagnosed with dementia or Alzheimer’s to services that help them prepare for a future with dementia. These can include dementia and participation in clinical trials.
“Knowing that most older adults have a primary-care physician and often visit them several times per year, we directed the KAER process to that primary audience to raise their awareness of the need to begin discussing the importance of brain health for all older patients — even those with no symptoms or concerns about memory problems or other cognitive changes,” Dr. Richard Fortinsky, chair of the Gerontological Society workgroup, said in a press release.
“This toolkit is a valuable resource because it brings together in one place an extensive amount of existing evidence-based, practical, and easy-to-use guidance to the busy primary-care provider about how to work with older adults and their families who are concerned about brain health and cognitive decline,” he said. “To our knowledge, there is no other such comprehensive and evidence-based toolkit available to clinicians [doctors] and health systems.”
Katie Maslow was the workgroup member who oversaw the development of the toolkit, which Eli Lilly and Company played a role in.
“We have tried to offer assessment tools and materials primary-care providers can share with their patients in an easily accessible format,” said Maslow, a social worker. “Another advantage of the toolkit is that it provides rationales for the four steps and choices of tools and materials so that primary-care physicians can select what will work best for them.
“We also provided a choice of tools whenever possible,” she said. “One reason for that is that some primary-care providers may already be using a tool for a particular purpose — for example, a brief cognitive assessment instrument. Another reason is that primary-care providers practice in a wide array of settings, including single-provider offices, physician group practices, and large, multi-provider healthcare systems. Particular tools may fit better with particular primary-care practice settings.”