Document text
Principal Investigator: CINDY J. NOWINSKI
Organization: NORTHWESTERN UNIVERSITY AT CHICAGO
Fiscal Year: 2024
Award: $760,331
Funding agency: National Institute on Aging
PROJECT SUMMARY
Our objective is to widely implement and evaluate a user-centered, scalable, telemedicine - linked strategy
for the routine detection of cognitive decline during the Annual Wellness Visit. Cognitive impairment is
most prevalent among adults 65 and older, yet less than half of cases are detected and/or diagnosed in primary
care settings. It is now increasingly accepted that early detection is critically important to optimize care planning,
sustained independence, management of chronic conditions and appropriate caregiver involvement. In 2011,
Medicare initiated a covered, Annual Wellness Visit (AWV) that includes a cognitive assessment to detect
impairment, Alzheimer’s disease and related dementias (ADRD). In April 2020, the Coronavirus Preparedness
and Response Supplemental Appropriations Act allowed healthcare systems to conduct AWVs remotely via
telemedicine to protect older patients at greater risk of adverse outcomes due to the coronavirus disease 2019
(COVID-19). The expansion of telemedicine as a viable means of healthcare deliver is likely to continue. While
this presents new opportunities for case finding, implementation of AWVs in primary care, including how cognitive
function is assessed, has been variable. Clinicians often rely on more basic, “paper”-based, interviewer-
administered cognitive tests that may be less precise and more cumbersome to clinical workflow – affecting the
fidelity of an early detection strategy. Further, many practices lack a clear protocol for referral when impairment
is determined, and a process for family involvement and establishing care goals. Practical, sustainable, scalable
strategies are urgently needed to help primary care providers routinely assess cognitive function as part of AWVs
(or whenever a cognitive impairment is suspected), identify concerns and have a protocol for referrals and care
management.
Northwestern developed and continues to innovate the NIH Toolbox for the Assessment of Neurological and
Behavioral Function®. Since 2017, our team has worked closely with primary care practices to develop a brief,
technology-enabled, self-administered, EHR-linked cognitive assessment (MyCog) derived from the NIH Toolbox.
We also devised a detailed protocol for its use and how results of a 5-7 minute test, can inform patient care. We
now propose creating MyCog Mobile to enhance, validate and evaluate the feasibility of the administration of a
brief cognitive assessment to detect MCI or AD delivered within an Annual Wellness visit conducted via
telemedicine.
Our primary aims are to: 1) Adapt the MyCog paradigm for use in telemedicine using patients’ own smartphones;
2). Validate MyCog Mobile in an existing, well-characterized and diverse cohort of adults ages 65-85; and 3).
Evaluate the feasibility, acceptability, and fidelity of MyCog Mobile implementation in a primary care practice as
preparation for future large-scale testing.
Terms: <21+ years old><65 and older><65 or older><65 years of age and older><65 years of age or more><65 years of age or older><65+ years><65+ years old><> 65 years><AD dementia><AD related dementia><ADRD><Abbreviations><Address><Adult><Adult Human><Affect><Age><Aged 65 and Over><Alzheimer Type Dementia><Alzheimer disease dementia><Alzheimer sclerosis><Alzheimer syndrome><Alzheimer's><Alzheimer's Disease><Alzheimer's and related dementias><Alzheimer's disease and related dementia><Alzheimer's disease and related disorders><Alzheimer's disease or a related dementia><Alzheimer's disease or a related disorder><Alzheimer's disease or related dementia><Alzheimer's disease related dementia><Alzheimers Dementia><Ambulatory Care><Amentia><Android App><Android Application><Behavioral><COVID-19><CV-19><Care Givers><Caregivers><Caring><Cell Phone><Cell Phone Application><Cell phone App><Cellular Phone><Cellular Phone App><Cellular Phone Application><Cellular Telephone><Chronic><Client><Clinic><Clinical><Clinical Trials><Cognitive><Cognitive Disturbance><Cognitive Impairment><Cognitive aging><Cognitive decline><Cognitive deficits><Cognitive function abnormal><Cohort Studies><Communication><Communities><Concurrent Studies><Coronaviridae><Coronavirus><Coronavirus Infectious Disease 2019><Data><Dementia><Detection><Development><Diagnosis><Disturbance in cognition><Early Diagnosis><Electronic Health Record><Ensure><Family><Family Process><Federally Qualified Health Center><Feedback><Future><Gender><Goals><Health Care Systems><Health Insurance for Aged and Disabled, Title 18><Health Insurance for Disabled Title 18><Healthcare><Healthcare Systems><Impaired cognition><Impairment><Internal Medicine><Interviewer><Link><Managed Care><Measurement><Measures><Medicare><Medicine><Mobile Phones><Modification><NIH><NINDS><National Institute of Neurological Diseases and Stroke><National Institute of Neurological Disorders and Stroke><National Institutes of Health><Neurologic><Neurological><Outpatient Care><Paper><Patient Care><Patient Care Delivery><Patient Recruitments><Patients><Persons><Preparation><Preparedness><Primary Care><Primary Senile Degenerative Dementia><Protocol><Protocols documentation><Provider><Race><Races><Readiness><Risk><Sampling><Self Administered><Self Administration><Smart Phone App><Smart Phone Application><Smartphone App><Socio-economic status><Socioeconomic Status><Standardization><Technology><Telemedicine><Testing><Title 18><Training><United States National Institutes of Health><Validation><Visit><Well visit><Work><above age 65><adulthood><adverse consequence><adverse outcome><after age 65><age 65 and greater><age 65 and older><age 65 or older><age > 65><age of 65 years onward><aged 65 and greater><aged 65+><aged ≥65><ages><aging associated disease><aging related disease><care for patients><care of patients><caring for patients><case finding><cell phone based app><co-morbid><co-morbidity><cognitive assessment><cognitive defects><cognitive dysfunction><cognitive function><cognitive loss><cognitive testing><cohort><comorbidity><conference><convention><corona virus><coronavirus disease 2019><coronavirus disease-19><coronavirus infectious disease-19><developmental><disease of aging><disorder of aging><early detection><effectiveness testing><elderly patient><electronic health care record><electronic health medical record><electronic health plan record><electronic health registry><electronic medical health record><field based data><field learning><field study><field test><health care><health insurance for disabled><human old age (65+)><iOS app><iOS application><iPhone><iPhone App><iPhone Application><innovate><innovation><innovative><mild cognitive disorder><mild cognitive impairment><mobile app><mobile application><mobile assessment><mobile based assessment><mobile device application><mobile phone app><old age><older adult><older adulthood><older patient><outpatient treatment><over 65 years><participant recruitment><practice setting><preparations><primary care patient><primary care practice><primary care provider><primary care setting><primary degenerative dementia><providers from primary care><providers of primary care><racial><racial background><racial origin><remote visit><response><senile dementia of the Alzheimer type><smart phone><smart phone based assessment><smartphone><smartphone application><smartphone based app><smartphone based application><smartphone based assessment><socio-economic position><socioeconomic position><summit><symposia><symposium><telehealth><tool><uptake><validations><wellness exam><wellness examination><wellness visit><≥65 years>