Age-related dementia is a neurological disorder that afflicts as many as 5.7 million individuals in the United States. While primary care physicians may screen older patients for dementia based on memory loss and other factors, symptoms are often vague, and delayed — or no — diagnosis is common.[i] In other cases, physicians may mistake treatable conditions for dementia and never correct them.

In order to address these challenges, three leaders in the healthcare space leaders joined forces to explore the potential of a new model for screening patients for dementia in the primary care setting.

Quest Diagnostics and the University of California, San Francisco (UCSF)’s Memory and Aging Center, in the UCSF Weill Institute for Neurosciences, one of the world’s leading dementia research and clinical centers, have designed a “clinical pathway” intended to help guide primary care physicians through each step of the screening journey. Primary PartnerCare ACO Independent Practice Association, Inc., New York’s only primary care-focused accountable care organization, will pilot the approach with a subset of physicians.

While facets of the Quest-UCSF pathway have been published in several peer-reviewed journals, Primary PartnerCare will be the first organization to test its value in a real-world clinical setting. Patient enrollment for the study is expected to begin during the summer 2018, with initial study findings available in mid-2019.

The pathway includes several components, including a decision tree based on best practice to guide cognitive screening and lab test ordering and interpretation; a 10-minute, tablet-based neurobehavioral assessment sensitive to mild cognitive impairment; and multi-media education materials for patients, caregivers and healthcare providers.

The pathway also includes standards for using neuroimaging, such as MRIs, and an algorithm for classifying patients into major dementia categories. For this facet of the study, the collaboration will engage Zwanger-Pesiri Radiology based in New York, Long Island.

“Delayed and incomplete diagnosis of dementia creates unnecessary costs to the healthcare system and heartache for families and caregivers,” said Harry Jacob, MD, Director Primary PartnerCare. “Primary care physicians are on the front lines of the dementia crisis as they are often the first to evaluate a patient, but they may lack the tools to reliably screen for cognitive impairment, refer to a specialist, and initiate care. The clinical pathway created by Quest and UCSF holds great potential to address these challenges, and we look forward to piloting it with our physicians and patients.”

“Primary PartnerCare has a record of setting the standard in outstanding quality and patient care in New York. Their commitment to innovation and care needs makes them the ideal collaborator to pilot the Quest-UCSF pathway in a primary care setting,” said Jay G. Wohlgemuth M.D. Senior Vice President, R&D, Medical and Chief Medical Officer.

Innovation and collaboration to improve dementia screening

The new research builds on long-standing collaborations between Quest Diagnostics, UCSF and Primary PartnerCare ACO. In 2014, Quest and UCSF formed a collaboration to accelerate the development of precision medicine diagnostics in cancer, dementia and other conditions. Since that time, the two organizations have jointly presented on a novel clinical pathway and other research in dementia.

Primary PartnerCare was the first ACO to employ Quest’s CogniSense Digital Dementia Assessment Test. CogniSense helped reduce unnecessary specialist referrals and gave front-line physicians a reliable measure of cognitive impairment to follow over time. The test was also well received by patients and physicians.

Through its Athena Diagnostics business, Quest has long championed new laboratory services to aid the diagnosis of neurological disorders, including dementia. In 2017, the company introduced a novel service that provides a ratio of two peptides (amyloid beta 42 and amyloid beta 40) found in cerebrospinal fluid to aid screening for Alzheimer’s disease. The company hopes to eventually transition to a blood sample so more people can access insights from the service.

More than 5.7 million people in the United States are living with dementia, which includes Alzheimer’s disease. According to the Alzheimer’s Association, accurate and early diagnosis of Alzheimer’s could save the U.S. more than 5.7 trillion in medical and costs.

Effects of Delayed Dementia Diagnosis include:

  • Wrong tests ordered, wrong treatment given
  • Duplicate MRI and other imaging scans
  • Sizeable medical costs as the correct diagnosis is sought
  • Missed opportunity for curative treatments for treatable causes of dementia
  • Inappropriate referrals to specialists (too many and too few)
  • Missed opportunity to improve medical compliance
  • Patients lose opportunity to guide their own life planning

[i]http://idrp.pbrc.edu/faq.htm