https://www.techtarget.com/virtualhealthcare/feature/Integrating-digital-cognitive-assessments-into-primary-care
With no current cure for dementia, early diagnosis is critically important to slow the progression of the disease and enable patients to plan for the future. Assessing patients for mild cognitive impairment (MCI), which is an early indicator of Alzheimer's disease and other dementias, could help address the issue; however, time constraints hinder routine testing.
This is why researchers at the University of Massachusetts Chan Medical School sought to examine the feasibility of integrating a digital cognitive assessment into routine primary care visits. Not only did they find the approach feasible, but they also observed that patients wanted to know their MCI results and were willing to perform the assessment.
Though integrating the digital assessment may require changes to the appointment workflow, researchers highlighted the primary benefit of the approach: reducing dementia burden by catching the disease early.
According to the Alzheimer's Association, MCI is an early stage of memory loss or loss of other cognitive abilities, such as language or visual/spatial perception. MCI is often noticed by the person who has it or their loved ones, but typically does not affect their ability to engage in daily activities. Some people with MCI may go on to develop dementia, but others do not.
MCI prevalence is widespread in America, with research showing that 22% of U.S. adults 65 and over have MCI.
MCI assessments take various forms, including interviews, paper-and-pencil tests, or computer-based tests. During assessments, clinicians may examine a wide array of factors, including memory, reasoning, language and motor skills.
Honghuang Lin, PhD, professor of medicine and co-director of the Program in Digital Medicine at UMass Chan Medical School, noted that even a person's voice can serve as a digital biomarker to assess cognitive health.
"Speech usually is one of the first signs of cognitive impairment," he said, adding that acoustic and linguistic features, as well as specific speech patterns, can be indicative of potential MCI.
Assessing patients for MCI during routine primary care appointments could help increase early detection of the disease; however, there are many competing priorities during the typical primary care appointment.
"[A primary care visit is] like 20 minutes, and a patient may see their primary care [provider] like once a year," Lin said. "There's so many things you have to do. So, if we have a digital cognitive assessment that can be very easy to implement, but it can also provide enough information about the patient's cognitive health, that would be very useful."
This is where Linus Health's Core Cognitive Evaluation (CCE), a tablet-based cognitive assessment tool, comes in.
Lin, who has worked with Linus Health for many years, noted that the CCE is convenient and provides adequate information to assess MCI. The CCE includes an immediate recall task, a digital clock drawing test and a delayed recall task administered via a tablet. A machine learning algorithm analyzes the user's performance and determines their score on a scale of zero to five, with zero indicating cognitive impairment.
The CCE also includes a qualitative survey that screens for modifiable lifestyle, psychosocial risk and protective factors related to brain health.
Lin and his fellow researchers conducted a study to determine whether the digitally conducted CCE could effectively be integrated into primary care workflows. They published their findings in JMIR Formative Research.
The researchers recruited patients 65 or older with primary care appointments at UMass Memorial Medical Center. Participants completed the CCE in-office prior to their appointment. The results were immediately uploaded into the Linus Health portal, which generates a report for the PCP.
The study included 150 patients who completed the CCE between March and December 2023. The CCE identified 40 patients with borderline MCI and seven patients with cognitive impairment.
Based on surveys with the participating patients, researchers found that a majority reported being able to easily complete the CCE (96%) and stated that completing it was beneficial (70%). Most patients (87%) agreed or strongly agreed they would like to know their CCE results.
"Most of them also want to know what is happening with their cognitive health, because [even though] many people don't want to talk about cognitive health, they still want to know what's happening," Lin said.
Additionally, the researchers surveyed seven PCPs whose patients completed the CCE. A majority of the PCPs (71%) said that the CCE did not interfere with patient visits and did not cause any stress or challenges for their patients (86%). Most PCPs (57%) also reported that the CCE did not cause them any stress or challenges. Among those who said that the CCE did cause them stress, the reasons cited included the difficulty of sharing poor CCE scores with patients.
Still, all PCPs stated that they generally agreed with the CCE results, and a majority (86%) said that the results changed their patient care management.
Researchers concluded that the CCE caused "minimal disruption to the practice workflow."
However, some changes to the workflow are essential to support the integration of the digital assessment. Lin noted that some patients needed technical support, requiring a research assistant or study call coordinator to be on hand to help them with the technology.
Not only that, but patients had to be brought in early for their primary care appointments to complete the assessment, which meant that primary care offices had to adjust their schedules.
Thus, researchers stated in the study that the next step will entail implementing the digital cognitive impairment screening tool within real-world primary care settings. Only then will it become clearer how difficult it would be to address the above logistical challenges.
For now, Lin and his team have answered the initial question of feasibility, but implementation will require buy-in from leadership and primary care offices.
"We're just showing the 'yes,'" Lin said. "And then people can decide whether they fully want to move forward or not."
Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.
02 Jul 2025