An innovative health systems approach to support early detection of cognitive impairment in primary care - the brain health navigator

Abstract

Background: Patients and providers experience barriers to early detection of mild cognitive impairment (MCI) and dementia. We developed a new primary care-based role, the Brain Health Navigator (BHN), who is trained to assess patients for cognitive impairment, identify addressable causes, suggest appropriate diagnostic testing, connect patients to resources, and assist patients in accessing disease-modifying treatments and dementia care management. This study describes the BHN role, the feasibility of implementing the BHN in Primary Care (PC) clinics, and the initial patients' outcomes for those who saw the BHN. Methods: Patients ≥65 years were screened with a Digital Cognitive Assessment (DCA) in seven PC clinics from June 1, 2022, to May 31, 2023. Patients who scored likely cognitively impaired or borderline for impairment were eligible for referral to the BHN. Clinics and providers could determine if referrals were automatic or on a patient-by-patient basis. The BHN encounter included a comprehensive assessment of standardized tools and suggested laboratory and imaging studies to facilitate the diagnostic process and connect patients to resources, care and treatment, and research opportunities. Results: 466 of 861 patients with likely impaired or borderline impaired DCA results were referred to the BHN.More patients with likely impaired scores (62.7%) were referred to the BHN compared to those with borderline scores (47.6%). Of the 466 referred patients, 28.9% with likely impaired scores and 23.5% with borderline scores completed a BHN visit. Patients who were seen by the BHN had a significantly higher likelihood of receiving a new diagnosis of MCI than patients who did not see the BHN and were more likely to have orders for diagnostic tests, such as vitamin B12 thyroid function and Magnetic Resonance Imaging of the head and neck. Referrals to both neurology and neuropsychology were significantly more common among patients who completed the BHN visit. Conclusions: A BHN enhances follow-up care and monitoring for patients with abnormal cognitive screening tests. A BHN visit increases the rate of evidence-based diagnostic evaluation for MCI and dementia in PC.