Browsing by Author "Murray, James"

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    Feasibility and Acceptability of Using Plasma Biomarkers for Diagnosing Alzheimer’s Disease in Primary Care
    (Oxford University Press, 2023-12-21) Fowler, Nicole; Swartzell, Kristen; Hammers, Dustin; Brosch, Jared; Murray, James; Willis, Deanna; Medicine, School of Medicine
    Blood-based biomarkers (Aβ, P-tau, neurofilament light) are clinically available to aid in the diagnosis of Alzheimer’s disease and related dementias (ADRD). However, no research has examined the use of blood biomarkers to aid in the diagnosis of ADRD in primary care (PC). Our study will test feasibility and acceptability of implementing blood-based biomarkers for ADRD in PC. Participants include: all PC patients ≥65 years presenting to one of six PC clinics between 6/1/22 and 5/31/23 who score cognitively impaired on the Linus Health Digital Clock and Recall (DCR™), and PC providers (PCPs) of these patients. Patients will view a decision guide about biomarkers and complete the Concerns about Alzheimer’s Disease Dementia Scale, and the Future Time Perspective Scale and the Impact of Events Scale. These measures and the PHQ-9 and GAD-7 will be repeated within 2 weeks of results disclosure. PCPs will receive training on biomarker disclosure techniques and best practices. To date 9 PCPs have consented to provide the biomarker results disclosure and 11 have declined. Following completion of PCP consent (n=100), a total of 200 patients who failed the DCR are eligible to be approached for consent. By November 2023, we anticipate that 150 patients will have completed biomarker testing, and we will have examined the biomarker results in the context of patient neuropsychological and clinical data, comorbidities, and sociodemographic information. This study will provide information regarding feasibility and utility of ADRD biomarkers in PC and a preliminary analysis of biomarker results compared with the patients’ clinical profiles.
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    Implementation of a Digital Cognitive Screening Program for Dementia in Primary Care
    (Oxford University Press, 2023-12-21) Fowler, Nicole; Mullavey, Judy; Swartzell, Kristen; Hammers, Dustin; Brosch, Jared; Murray, James; Willis, Deanna; Medicine, School of Medicine
    Early identification of Alzheimer’s disease and related dementias (ADRD) has become paramount given the emergence of disease modifying therapies. Integration of rapid, scalable tools to identify early cognitive impairment in primary care is essential because most at-risk individuals have limited access to specialty care. Yet, competing demands on primary care practices can make integration challenging. This demonstration project is being conducted to understand the feasibility, acceptability, and implementation of digital cognitive screening in primary care. Patients ≥65 years presenting to one of six primary care sites between 06/01/2022 and 06/30/2023 are asked to complete the Linus Health Digital Clock and Recall (DCR™) cognitive screening. Data regarding number of screening attempts that were refused, incomplete, or completed was collected. Results of the first completed screening-results were analyzed using descriptive statistics. As of 2/15/23, there are 3,920 screening attempts. DCR™ screenings were completed 40.8% of the time, refused 57.4%, and attempted but incomplete 1.8%. Thirteen-percent of attempts were positive for cognitive impairment, 37% were borderline, 44% were unimpaired, and 6% were unanalyzable. Average patient age is 73.2±6.0 years, 58% female, and 6% report less than high school education. Patients with positive screenings are older, slightly more female, and reported less education. Cognitive screening via DCR™ is ongoing and has been completed in nearly half of those approached, with half scoring cognitively impaired or borderline. This approach appears to have utility in early detection of cognitive impairment in primary care. By November 2023 we will have follow-up data for patients who screened positive.