Jarrod A. Carrol, MD

As the incidence and prevalence of dementia increases, the need for appropriate assessment and treatment of memory complaints in primary care will become ever more important. Early identification of cognitive impairment and competency in its differential diagnosis is a skill that providers will need in their daily practice as delay in diagnosis can have significant implications.

This quality improvement project organized by Parks et al aims to address this growing need in primary care by first identifying barriers and then integrating memory assessment and care in that setting. Working alongside primary care providers and in patients’ homes, consulting geriatricians used validated tools in a multipronged approach to patient evaluation. In a visit separate from the routine medical visit, the geriatricians were able to assess the patient’s cognitive function, psychosocial factors, functional status and behaviors, which are key in the evaluation and management of dementia. Through their work, they were able to identify new dementia diagnoses, counsel patients (and families), and have important discussions about the diagnosis.

While improving recognition of dementia in primary care is needed, a high value model of dementia care will also focus on the management of this permanent and progressive condition. As current pharmacologic treatments show only modest effects on cognition, providers should have a grasp of nonpharmacologic care including a team-based approach (physician, nurse case management, social worker, pharmacy, etc.), available community resources and approaches to manage behavioral and psychological symptoms of dementia. Throughout the disease course, the patient remains the focus, but integrating family, friends and caregiver(s) early is beneficial because they often serve as informants about cognitive changes, help implement and monitor management techniques and provide context in disease progression. Given their role, family and caregivers should be connected to available community resources aimed at educating them on dementia care. Furthermore, assessing for caregiver stress and strain as dementia progresses is an integral part of dementia care as caregiver burden can impact patient care and lead to early institutionalization.

In order to improve dementia care, health care systems will need to create more “space” for cognitive evaluation and care. This space (ie, education/training, time provisions, dedicated care teams, etc.) will equip physicians with the necessary tools to manage dementia in the primary care setting. Parks et al have developed a road map to this space, starting with integrating geriatricians into the primary care clinic on a small scale in hopes of increasing awareness and education. Armed with the necessary tools, primary care providers will be able to adopt similar approaches to improve diagnosis and management of patients with dementia in their everyday practice.