Friday, October 11, 2024
10/11/2024
R33 Phase Abstract The purpose of this project is to implement an automated risk assessment and cognitive screening application (RACS app) in primary care settings and to validate its clinical utility. The study aims have not been modified from the original application and are to refine and further validate the RACS app with diverse patient populations, assess the usability of the tool by primary care providers (PCPs), and implement and test procedures for integrating the tool into multiple electronic health systems. We hypothesize the following: 1. The cognitive processing (CP) score of the RACS app will exhibit good classification accuracy in detecting cognitive impairment when compared to an established brief cognitive assessment tool, the Quick Mild Cognitive Impairment (Qmci) screen, and to a more comprehensive neuropsychological test battery (NTB); 2. The CP score will detect cognitive decline over time as determined by rate of change on the Qmci and NTB and by pre-established indicators of progression pulled from the medical record (e.g., functional decline, need for cognitively enhancing medication, diagnosis of cognitive disorder). 3. The RACS app will be rated as useful and easy to use by clinic staff and require minimal staff time. A total of 500 older adults will be recruited from two primary care clinics affiliated with The University of Texas (UT) at Austin, the Family Wellness Center (FWC) and UT Health Austin’s Primary Care Clinic (PCC). Participants will be recruited consecutively according to the following inclusion/exclusion criteria: (1) Aged 60 years and older; (2) ethnic/racial background consistent with NIH policy; (3) male or female; (4) fluent in English, (5) no confounding conditions that could impact ability to participate in the study (e.g., cognitive impairment sufficient to impact ability to follow instructions on the iPad, motor impairment that would prohibit independent use of RACS, poor visual acuity), and (6) no prior diagnosis of dementia. Enrolled participants will complete the RACS app and Qmci at baseline, 6 months, and 12 months later and will be asked to complete an optional brief NTB at baseline and 12 months. Clinic staff who use the RACS app will be asked to complete a usability questionnaire after each of the first 10 uses. Means, standard deviations, and proportions will be computed to describe the study groups and to summarize dependent variables. Correlational analyses will be conducted to explore relationships between the CP score and demographic characteristics of the sample, as well as between the CP score, Qmci, and NTB global composite Z score. Classification accuracy of the CP will be compared to that of the Qmci and NTB. To determine usability of the RACS app, we will employ qualitative and quantitative methods to examine the 20- item USE questionnaire and time stamps for use of the RACS app. Successful completion of this project has the potential to make a significant impact on early detection of cognitive decline in a low-cost, low-burden manner. By providing an automated tool developed specifically to address the needs of PCPs, it will be easier to screen for cognitive impairment, increasing the number of older adults who are screened and subsequently identified as cognitively impaired. Early identification of individuals with cognitive impairment will facilitate earlier application of appropriate interventions and participation in research trials, which has both personal and societal benefits.
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