ICreate

Background

Currently, around 1.8 million people with dementia live in Germany (Blotenberg, Hoffmann & Thyrian, 2023). General practitioners' practices are the first point of contact for people with dementia in Germany. However, current estimates assume that less than 10% of all patients with prodromal and only around 40% of all patients with manifest dementia are identified in primary care (Bohlken & Kostev, 2019; Eichler et al., 2014; Lang et al., 2017). A survey of affected patients, caregivers and stakeholders found that improved early detection of dementia ranks third among the ten most important care topics (Kelly et al., 2015).

The guideline-compliant diagnostic assessment of dementia is time-consuming and often takes place in expert centers. However, primary medical care plays a crucial role in identifying patients who could benefit from such an assessment and helps to avoid mistreatment, under-treatment or over-treatment.

Against this background, digital cognitive short tests (Chan et al., 2021) and optimized cooperation with specialized centers offer the opportunity to identify people in the early stages of dementia in primary medical practice as a cost-effective, widely available and time-saving case-finding test and to make adequate diagnostics and care available to them (Mattke et al., 2020).

Aim of the project

The aim of our study is to improve the diagnosis and care of patients with dementia, especially in the early stages, through improved case-finding in primary medical care. This is to be achieved with the help of a tablet-based cognitive test that is carried out in the cooperating general practitioner practices under the guidance of previously trained MFAs and evaluated automatically. Depending on the test result, this can either mean referral to a memory clinic for further diagnostics and therapy, follow-up testing in 12 months, or no further measures are necessary.

Project sequence

In 10 general practitioner practices in the Bonn/Rhein-Sieg region, all patients over 60 will be offered an optional "memory check" as part of their health check-up. Patients can also be offered testing if they report cognitive complaints or if dementia is suspected.

After informed, written consent to participate in the study, MFAs will conduct a commercially available, self-administered tablet-based Montreal Cognitive Assessment (MoCA; Nasreddine et al., 2005) with automated evaluation with the patients. The test is followed by a short digital questionnaire on motivation, experience, user-friendliness, and satisfaction with the test. Patients who refuse to participate will be asked to fill out a questionnaire anonymously. The participating MFAs, general practitioners and 40 patients will be asked about their experiences with the testing using qualitative interviews. From this and from the patient questionnaires, we will obtain data on acceptance, feasibility and implementability in everyday practice and use this to derive recommendations for further optimization.

The patients will be asked for their consent to pass on the test results to their treating general practitioner and, in accordance with the recommendations of the automated test evaluation, will either be referred to the memory clinic at the UK Bonn, followed up over the course of 12 months or informed of an unremarkable test result.

In addition to the established diagnostics, the memory clinic will use a newly developed additional digital tool that has the potential to enable valid tests similar to the MoCA in an even shorter time and fully automated in the future.

Bibliography

1. Blotenberg, I., Hoffmann, W. & Thyrian, J. R. (2023). Dementia in Germany: Epidemiology and prevention potential. Deutsches Arzteblatt International.
2. Bohlken, J., & Kostev, K. (2019). Diagnostic behavior for mild cognitive impairment in general and neuropsychiatric practices in Germany. Journal of Alzheimer's Disease, 68(3), 925-930.
3. Eichler, T., Wucherer, D., Thyrian, J. R., Kilimann, I., Hertel, J., Michalowsky, B., ... & Hoffmann, W. (2014). Antipsychotic drug treatment in ambulatory dementia care: prevalence and correlates. Journal of Alzheimer’s disease, 43(4), 1303-1311.L. Lang et al. BMJ Open 7, e011146 (2017).
4. Lang, L., Clifford, A., Wei, L., Zhang, D., Leung, D., Augustine, G., ... & Chen, R. (2017). Prevalence and determinants of undetected dementia in the community: a systematic literature review and a meta-analysis. BMJ open, 7(2), e011146.
5. Kelly, S., Lafortune, L., Hart, N., Cowan, K., Fenton, M., & Brayne, C. (2015). Dementia priority setting partnership with the James Lind Alliance: using patient and public involvement and the evidence base to inform the research agenda. Age and Ageing, 44(6), 985-993.8. S. Mattke et al. Alzheimers Dement (Amst) 12, e12081 (2020).
6. Chan, J. Y., Yau, S. T., Kwok, T. C., & Tsoi, K. K. (2021). Diagnostic performance of digital cognitive tests for the identification of MCI and dementia: A systematic review. Ageing Research Reviews, 72, 101506.
7. Mattke, S., Cho, S. K., Bittner, T., Hlávka, J., & Hanson, M. (2020). Blood‐based biomarkers for Alzheimer's pathology and the diagnostic process for a disease‐modifying treatment: projecting the impact on the cost and wait times. Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring, 12(1), e12081.
8. Nasreddine, Z. S., Phillips, N. A., Bédirian, V., Charbonneau, S., Whitehead, V., Collin, I., ... & Chertkow, H. (2005). The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society, 53(4), 695-699.