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Implementation of a targeted screening program for Alzheimer's disease risk in a primary care setting
Author(s) -
Korthauer Laura E,
Denby Charles,
Molina David,
Wanjiku Janet,
Daiello Lori A,
Drake Jonathan D,
Grill Josh D,
Ott Brian R
Publication year - 2020
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1002/alz.043107
Subject(s) - medicine , apolipoprotein e , disease , cognition , family history , dementia , alzheimer's disease , primary care , genetic testing , memory clinic , population , gerontology , psychiatry , family medicine , environmental health
Background Primary care providers (PCPs) are well‐positioned to promote early detection of cognitive impairment, yet the value of comprehensive screening of Alzheimer’s disease (AD) risk factors has received limited attention. The goal of this pilot study was to evaluate the feasibility of implementing a population health approach to screening for cognitive and genetic risk for AD in a primary care setting. Method PCPs (N=6) referred patients with a family history of AD or memory complaints (N=94) to the Rhode Island Alzheimer’s Disease Prevention Registry for apolipoprotein E (ApoE) genotyping and a telephone‐based cognitive screen (Minnesota Cognitive Acuity Screen). PCPs informed patients of testing results (ApoE status, cognitive screening diagnosis) and counseled them about risk factor modification. The impact on patients’ understanding of their AD risk and providers’ care management was subsequently assessed via surveys. Result Twenty‐three participants (31%) had probable mild cognitive impairment; 30 participants (35%) had one or two ε4 alleles. More cognitively normal (93%) than MCI patients (50%) correctly recalled their cognitive screening results ( p =.003). Compared to cognitively normal patients, MCI patients correctly reported a higher likelihood of developing AD ( p <.001). More ApoE non‐ε4 carriers (100%) than ε4 carriers (80%) correctly recalled their genetic test results ( p <.001); both groups correctly reported that the ε4 allele confers greater AD risk. PCPs reported recommending lifestyle changes (e.g., diet, exercise, cognitive stimulation) to 99% of patients, but only 27% of patients reported that this recommendation was made. However, patients who recalled being given a lifestyle recommendation were significantly more likely to have enacted a lifestyle change (OR=7.2; p =.01) than those who did not recall this recommendation. Each PCP reported that the program was a valuable addition to their practice and benefitted their care management. Psychological distress was reported in <5% of participants (1 MCI‐positive, 3 ε4‐positive individuals). Conclusion Given the increasing focus on cognitive health in aging, population health initiatives delivered in primary care are needed to offer guidance to at‐risk patients. Implementing a cognitive and genetic screening program for AD risk in a primary care setting is feasible and may provide added value to PCPs in advising patients about risk factor modification.