IBX, Jefferson Health experts explain how new program will improve early dementia detection in primary care

A new dementia care initiative at Jefferson Health is aiming to help primary care clinicians detect cognitive decline earlier and guide patients and families through the next steps of diagnosis and care. The effort is supported through a grant from Independence Blue Cross and focuses on improving how mild cognitive impairment and early Alzheimer’s disease are identified and managed in primary care settings.

The program, led by Barry Rovner, M.D., a professor in the Department of Psychiatry, Neurology and Ophthalmology, tests whether adding structured screening tools and additional patient support can improve early detection and care planning. Rodrigo Cerdá, M.D., M.P.H., senior vice president of health services and chief medical officer at Independence Blue Cross and member of MHE’s editorial advisory board, said the initiative is designed to help clinicians manage a complex condition during already busy primary care visits.

“Early cognitive impairment and early Alzheimer’s dementia are often underdiagnosed for a variety of reasons, including limited time for screening and for setting up the necessary workup,” Cerdá said. “Primary care is the right place because of the continuity and relationship with patients, but clinicians are responsible for many other things in a very time-limited visit. The program takes some of that work out of the visit while keeping decisions within the trusted relationship between patient and clinician.”

The project compares two approaches. One group will receive enhanced usual care that includes screening and standardized order sets to guide diagnostic evaluation. The second group will also receive support from a community health worker who speaks with patients and caregivers about goals, preferences and education related to dementia.

The community health worker then shares that information with the primary care clinician, allowing the provider to continue the diagnostic process with more context and preparation.

James Ellison, M.D., M.P.H., a geriatric psychiatrist at Jefferson Health, said diagnosing dementia meaningfully requires more than a simple screening test. Clinicians must evaluate multiple factors that can affect cognition and determine the underlying cause.

“Meaningful diagnosis is more than just a positive screen on a test like the Montreal Cognitive Assessment or Mini-Mental State Exam,” Ellison said. “Clinicians must look at lifestyle factors such as sleep and medication use, evaluate possible medical contributors and determine the underlying cause of cognitive decline. That process helps guide the right treatment and support for patients and their families.”

Researchers will compare outcomes between the two approaches to see whether additional patient support and structured screening improve diagnosis and care planning for people experiencing early cognitive changes.