A recent study conducted by the Regenstrief Institute has uncovered a significant prevalence of unrecognized cognitive impairment among older adults visiting Federally Qualified Health Centers (FQHCs). This research highlights a particularly troubling trend among minoritized populations, indicating that early and equitable detection of cognitive issues is crucial for improving health outcomes.
FQHCs provide essential primary care and preventive services to over 30 million patients, regardless of their ability to pay or health insurance status. As the number of older adults seeking care at these facilities increases, understanding cognitive impairment becomes increasingly vital.
The study involved 204 socially and economically vulnerable older adults, with an average age of 70. Findings revealed that African American participants were more than twice as likely to experience unrecognized cognitive impairment, including mild cognitive impairment and dementia. Specifically, approximately 82 percent of Black patients had undiagnosed dementia or mild cognitive impairment, compared to 64 percent of White patients. Alarmingly, only 26 percent of all participants exhibited no cognitive impairment.
The study cohort was predominantly female and slightly more than half identified as African American. Notably, the relationship between race and cognitive impairment remained consistent across different sexes, ages, and levels of education.
Participants were managing an average of three chronic medical conditions, such as diabetes, heart disease, hypertension, or chronic obstructive pulmonary disease, and were taking an average of five medications. To assess cognitive health, researchers conducted interviews with patients and family members, reviewed three years of medical records, and administered comprehensive cognitive tests and neurological examinations.
Dr. Malaz Boustani, the study’s senior author, noted the stigma associated with cognitive impairment diagnoses, which often leads patients and their caregivers to avoid discussing brain health with their primary care providers. “To provide quality care and overcome disparities and stigma, we must develop scalable, timely, equitable, and sustainable approaches for early detection of cognitive impairment, particularly in FQHCs that serve low-income and medically underserved communities,” he stated.
Early detection of cognitive impairment can grant patients and caregivers access to recent advancements in brain care. These include amyloid-lowering therapies that can alter the progression of Alzheimer’s disease, a new alternative payment model from the Centers for Medicare and Medicaid Services (CMS) to support comprehensive dementia care services, and lifestyle interventions aimed at reducing the risk of future cognitive decline through improved management of blood pressure, diabetes, cholesterol, sleep, depression, and physical activity.
Dr. Boustani and his team are also developing a cost-effective, scalable methodology using machine learning to analyze electronic health records for signs of cognitive impairment. This “zero minute assessment” aims to provide a culturally sensitive solution to a pressing healthcare issue that often lacks adequate time and financial resources for resolution.
The authors of the study assert that the racial disparities in cognitive impairment diagnoses stem from both a higher prevalence of dementia in African American communities and insufficient healthcare workflows that support timely detection and diagnosis.
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