Knowledge of cognitive status: Good for care, not for decline

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Nicole Fowler, PhD
Nicole Fowler, PhD

Primary care physicians given information on a patient's cognitive status provided more care focused on cognition, but that care had no effect on the overall rate of the patient's cognitive decline, according to the findings of a newly published study.

“We found that primary care physicians clearly value information about their patient's cognitive status, but they didn't know what to do with it,” says Nicole Fowler, PhD, first author of the study, published in Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring. “This study is not an indictment of physicians, but a critique of the way medicine is delivered to those with cognitive impairment. The care that we provide these vulnerable individuals could be improved if we make doctors more aware of what options are available especially as those options increase.”

The study involved 533 older western Pennsylvania adults receiving care in one of 11 primary care practices. Some physicians were given reports on patient's cognitive performance, and some were not.

Doctors who were informed of their patient's cognitive impairment were more likely to order diagnostic tests, prescribe medication and discuss memory problems with patients than doctors not made aware of the cognitive status of their patients.

Meanwhile, another study, recently published in The Lancet Neurology, demonstrates that the accuracy of brain imaging must be improved before it can be rolled out on a scale that could be useful to primary care physicians, other healthcare providers and patients.

Advances in technology have “fuelled a great deal of interest in the use of brain imaging to detect Alzheimer's disease and predict how and when dementia will develop in patients who are at risk,” said Chris Fox, a co-author of the study. Because patients can  be in various stages of the disease when it is diagnosed, however, and because changes in the brain can be detected years before the disease manifests clinically, it's not clear yet which types of images are useful for patients and which are not, he added.

“Primary care is usually a first point of contact for patients and provides a unique opportunity for early dementia diagnosis,” Fox said. “But evidence shows that only a small proportion of patients with dementia or cognitive impairment are recognized in this setting.”

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