Implementation of cognitive screening in primary care: DIGITAL‐ Indiana University Health System and Indiana University – A Davos Alzheimer’s Collaborative flagship site program

Background With the emergence of novel therapeutics, the importance of early identification of people at risk of developing Alzheimer’s disease is more critical than ever. Most asymptomatic at‐risk individuals are primary care patients, who often have limited access to specialty care. Therefore, development of feasible, acceptable, and scalable ways to identify early cognitive impairment in the primary care setting is essential. The DAVOS Alzheimer’s Collaborative DIGITAL Demonstration Project was conducted to understand the feasibility, acceptability, and implementation of digital cognitive screening in primary care. Methods Patients ≥65 years presenting for any issue to one of six Indiana University Health primary care sites between June and December 2022 were asked to complete the Linus Health Digital Clock and Recall (DCR™) cognitive assessment screening tool. Scores on the DCR™ range 0‐5, with 0‐1 categorized as cognitively impaired, 2‐3 as likely cognitively unimpaired, and 4‐5 as cognitively unimpaired. Data regarding number of DCR™ screening attempts that were refused, incomplete, or completed was collected. This pragmatic demonstration project allowed patients to be approached multiple times and complete the screening multiple times within the project time frame. Patients first completed screening test results were analyzed using descriptive statistics. Results Over the 7‐month project, 3,343 screening attempts were made. The screening test was refused by patients (54.6%) 1,825 times and was attempted but incomplete 64 (1.9%) times. 1,454 (43%) screenings were completed, which represents 1,405 unique patients. Among these, 172 (12%) scored positive for cognitive impairment, 506 (36%) scored likely cognitively impaired, 628 (45%) scored cognitively unimpaired, and 99 (7%) results were unanalyzable. Conclusions Using the DCR™, cognitive screening was successfully completed in nearly half of the primary care patients approached, regardless of their presenting concern, with 48% scoring either impaired or likely impaired. This cognitive screening approach appears to have utility in developing early detection for cognitive impairment in primary care, which will be an initial step towards identifying patients who could benefit from disease‐modifying therapeutics.