Are Geriatrics-Focused Primary Care Clinics Better at Diagnosing Dementia Than Traditional Clinics? A Matched Cohort Study

BackgroundDementia and mild cognitive impairment (MCI) are prevalent but underdiagnosed.ObjectiveTo compare new dementia/MCI diagnosis rates in geriatrics-focused primary care clinics and traditional primary care clinics.DesignSecondary analysis of a prospective matched cohort study that spanned 2017-2021.ParticipantsCommunity-dwelling Veterans over 65 receiving primary care in a geriatrics-focused medical home (GeriPACT) or traditional primary care home (PACT) at one of 57 Veterans Affairs sites. We excluded individuals with a documented diagnosis of dementia or MCI in the year prior to enrollment.Main MeasuresDiagnoses obtained from EHR. Cognitive status was assessed using modified Telephone Interview for Cognitive Status (mTICS) tool.Key ResultsThe 470 participants included in this analysis were predominantly white, non-Hispanic males with an average age of 80.3 years. 9.4% of participants received a diagnosis of dementia/MCI after 24 months: 11.5% in GeriPACT and 7.2% in PACT. Adjusted OR for dementia/MCI diagnosis based on GeriPACT exposure was 1.47 (95% CI 0.65-3.29). Low mTICS score (<= 27) (OR 4.89, 95% CI 2.36-10.13) and marital status (married/partnered) (OR 1.89, CI 0.99-3.59) were independent predictors of dementia/MCI diagnosis. When stratified by cognitive status: diagnosis rates were 20.8% in GeriPACT and 16.7% in PACT among those who scored lower on the cognitive assessment (mTICS <= 27); 7.4% in GeriPACT and 3.6% in PACT among those who scored higher (mTICS > 27). The OR for new dementia/MCI diagnosis in GeriPACT was 1.19 (95% CI 0.49-2.91) among those with a low mTICS score and 1.85 (95% CI 0.70-4.88) among those with a higher mTICS score.ConclusionsObserved rates of new dementia/MCI diagnosis were higher in GeriPACT, but with considerable uncertainty around estimates. Geriatrics-focused primary care clinics may be a promising avenue for improving the detection of dementia in older adults, but further larger studies are needed to confirm this relationship.

Automated summary

This study aimed to compare the new diagnosis rates of dementia/MCI in geriatrics-focused primary care clinics and traditional primary care clinics. The study found that the diagnosis rates were higher in geriatrics-focused clinics, but with considerable uncertainty. The study suggests that geriatrics-focused clinics may be a promising avenue for improving the detection of dementia in older adults, but further larger studies are needed to confirm this relationship.