Dementia Care Research and Psychosocial Factors

Background: Alzheimer's disease (AD) is a significant health concern affecting at least 10% of individuals aged 65 and older, with heightened risk in Black and Hispanic/Latino populations. Despite this prevalence, our analysis of University of California Los Angeles (UCLA) electronic health records (EHR) indicates that only 4% of patients aged 65 or older receive an AD diagnosis, with underdiagnosis more prevalent among Black and Hispanic/Latino patients compared to their white counterparts. To address this issue, we propose implementing a concise dementia screening tool (DST) in real-world clinical settings.

Method: The DST, developed through collaborative efforts among multiple University of California AD Centers and the California Department of Public Health, is a brief (<5 minutes) screening tool. It includes a three-question questionnaire for patients and, if available, their informants, followed by the Mini-Cog assessment if applicable. The questions address changes in language, memory, and personality. A positive DST result is defined as any "Yes" response by the patient or informant to any question or a Mini-Cog score below 3 out of 5 points. We have also created a Spanish version of the questionnaire tailored to the Hispanic/Latino cultural context.

Result: Integration of the DST into the EHR system facilitates a seamless implementation. Patients receive questionnaire through the EHR messaging system before appointments, with the Spanish version available for those who prefer it. Responses and Mini-Cog results are easily accessible in the EHR. Additionally, a documentation link automatically populates DST results, final scores, and recommendations into provider notes. The DST is currently in use at a large, diverse UCLA family medicine clinic serving Hispanic/Latino and Black patients. In the first fourteen months, 1,963 patients (Table 1) were seen, with 28% self-identifying as Hispanic or Latino. Among them, 1,070 patients answered at least one question, and 340 completed the Mini-Cog (Table 2). Notably, 31 patients received a new dementia diagnosis, and 81 were referred to Neurology.

Conclusion: Our implementation of the DST in a diverse clinical setting has successfully screened 1,070 participants, with future research comparing data from the DST period with a pre-time period.