Community Memory Screening May Improve AD Diagnosis and Care

Community-based memory screening may be an effective first-line approach to removing barriers to the diagnosis and care for Alzheimer’s disease and related dementias (ADRD), new research suggests.

Investigators found that about a third of individuals who received cognitive screening at community-based centers across the state of Wisconsin were referred to a primary care provider (PCP), which resulted in some receiving a dementia diagnosis.

"We showed that partnering with community organizations can help facilitate evaluations and dementia diagnoses," study investigator Lindsay R. Clark, PhD, assistant professor, Department of Medicine, Division of Geriatrics and Gerontology, University of Wisconsin-Madison, told Medscape Medical News.

The findings were presented at the Alzheimer's Association International Conference (AAIC) 2023.

Removing Barriers

The Memory Screening in the Community program was developed to provide cognitive screens for community members, known as "customers," through Aging and Disability Resource Centers (ADRCs) in every county across the state of Wisconsin.

Individuals, said Clark, may be attending these centers to inquire about housing and other types of support. Alternatively, ADRC staff members may organize community events such as information sessions on brain health or available resources.

Trained staff administer cognitive testing, including the Mini-Cog, Animal Naming, and/or AD8 instruments. "They use these screening tools to help guide a conversation about cognitive concerns and talk about potential recommendations or resources that may be available," said Clark.

For the study, center staff completed surveys for individuals attending ADRCs. The investigators gathered data on demographics, living arrangements, and reasons for the screening survey. If the testing scores or conversation with trained staff suggested possible cognitive impairment, individuals were referred to a PCP for further investigation.

The analysis included data from 738 initial surveys from 39 counties and five tribal communities in Wisconsin. About half of the evaluations — about 52% — were conducted during a walk-in or scheduled appointment.

The majority of individuals were White (93.8%) and female (70.5%). The most-represented age group was 70-79 years (32.2%), and about half lived alone.

Of the total cohort, 32.6% were referred to a PCP "because something came up or was raised that was concerning," said Clark.

About a quarter (24.6%) agreed to a post-screen follow-up at 6-9 months. Of these, 39 completed follow-up calls, 24 met with their PCP, and nine received a dementia diagnosis.

Community screening helps reduce barriers people with memory concerns face in getting an evaluation, said Clark. She noted Wisconsin has a large rural population where residents have difficulty accessing healthcare.

"The screening helps guide people to that next step, to get more follow-up on the potential cause of their cognitive impairment: Is it something like Alzheimer’s dementia or is it a potentially reversible cause?" said Clark.

Out of the Doctor's Office and Into the Community

Commenting for Medscape Medical News, Nicole R. Fowler, PhD, associate professor of Medicine, Indiana University School of Medicine, and director of Research, Indiana University Center for Aging Research, Indianapolis, said the study highlights the benefits of taking screening out of the doctor’s office and into the community.

Brain health screening, which is important for picking up possible dementia cases, is "even more crucial" now that more therapies are on the horizon, she said.

Memory screening in the community normalizes getting a baseline measure and "gives people a nudge" to get the follow-up they need, she added.

"It’s changing the setting and changing the messenger. It’s happening at community events or at church, and friends share it. People are more likely to do things their friends encourage them to do than their doctor," Fowler said.

The study received funding from the Centers for Disease Control and Prevention.

Clark and Fowler report no relevant financial relationships.

Alzheimer's Association International Conference (AAIC) 2023. Abstract #80672. Presented July 18, 2023.

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