Feasibility of the mini-cog as a standardized cognitive screen in HealthPartners patients aged 70 and older [poster]
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Background/Aims: Alzheimer’s Disease (AD) is present in one out of eight Americans over the age of 65 and nearly half of those older than 85. Cognitive screening for dementia in the asymptomatic population is not routinely performed due to the absence of evidence showing improved health outcomes. One of the barriers to testing the benefit of screening has been the lack of an easily implemented, efficient, and cost effective instrument for primary care. Two HealthPartners clinics are exploring the use of the Mini-Cog as a standardized screening tool for cognitive function in patients aged 70 and older. We report on the feasibility of administering a cognitive screening tool in the elderly population with the eventual goal of assessing the impact of undetected cognitive impairment on chronic disease management. Methods: Clinic rooming nurses were trained to administer the Mini-Cog, a test consisting of three word verbal recall and a clock draw. HealthPartners patients aged 70 and older without a prior diagnosis of AD or mild cognitive impairment were identified and flagged for screening during chart preparation the day prior to their appointment. The Mini-Cog was administered to flagged patients after collection of vital signs. Subjects scoring lower than four out of five possible points were considered screen failures and received further testing and follow-up from their provider or were referred to a dementia clinic for assessment. Results: Rooming nurses rapidly acquired the skills to administer the Mini-Cog. Cognitive screening took approximately 3 minutes and did not disrupt clinic work-flow. In the first three months of implementation, 101 patients were screened. The rate of Mini-Cog failure was 31%. The average patient age was 78 years old and 45% of patients were male. Future research is planned to address clinical outcomes and management of chronic medical conditions using data from the electronic medical records. Conclusions: The Mini-cog is an easily administered screen for detection of cognitive decline and an effective tool to test the potential benefits of cognitive screening in HealthPartners patients. Preliminary results demonstrate a higher failure rate than expected based upon estimated dementia prevalence rates.