Development of a Rapid Screening Tool for Cognitive Impairment in a Primary Care Setting: A Pilot Study

Objectives Fewer than half of dementia cases are identified and diagnosed. Barriers to timely diagnosis include lack of accurate, efficient screening tools for mild cognitive impairment (MCI), a frequent antecedent to dementia. While many screening tools are available, robust screeners (e.g., montreal cognitive assessment [MoCA]) take more time than primary care teams have available, and briefer tools (e.g., the Mini-Cog) aren't robust enough. We describe the development and validation of the Virginia Mason Cognitive Screener (VMCS), which meets the competing needs of efficiency and accuracy in screening for MCI and dementia. Participants One hundred fifty older adults volunteered to participate in a quality improvement effort. Participants were recruited from a primary care practice being seen for their Medicare annual wellness visits (MAWV), chronic disease management care, or neurology consultation in an urban multispecialty group practice. All participants completed the MoCA and a measure of semantic verbal fluency. The VMCS score was determined by extracting the clock draw and 5-word recall scores from the MoCA and incorporating the semantic fluency score. Subsequent diagnostic evaluation included neuroimaging, neurological evaluation, blood work, and neuropsychological testing. Diagnoses were determined after detailed chart review by a clinical neuropsychologist. Results The MoCA and VMCS were significantly correlated (Pearson r = 0.85, p