How a Memory Clinic Serving 40+ Counties Took Cognitive Screening on the Road
across 4 states, most with no structured cognitive screening infrastructure in place. Patients often reached care only after dementia had progressed to moderate or severe stages.
people screened in about a year by staff with no specialized testing training, using Creyos on an iPad to screen communities who were once hard to reach.
of those screened were flagged for cognitive impairment, most at an early stage, in a population that had gone unscreened before. Now they leave with a clear next step toward care.
"These are people who knew something was wrong. They noticed it, but they'd tell themselves it's normal aging. They used a lot of compensatory behaviors and kept it to themselves. And there was no system to catch it until they were in crisis."
A memory clinic built for one of the country's hardest-to-reach regions
The Garrison Institute on Aging Memory Clinic, part of Texas Tech University Health Sciences Center in Lubbock, serves one of the most spread-out and underserved populations in the country: more than 40 counties across 4 states, much of it rural West Texas, largely Hispanic and often below the poverty line. Many of these communities sit hours from the nearest specialist, in a region the federal government designates as medically underserved.
"We serve 1.5 million people from a health care standpoint," says Dr. Jonathan Singer, who directs the clinic, "but we don't have the specialists to meet the need." Under his direction, the clinic provides comprehensive dementia evaluations for patients and families spread across that vast territory.
He viewed the 2-step design of the Creyos dementia protocol as another strength. "If they do really well on the first 2 tasks, that's all I see, and they're good," he explains. "If they don't, they do a longer assessment, and I see the fuller picture." A patient doing well finishes in a couple of minutes, while one closer to the threshold gets the added depth, without anyone sitting through more than they need.
Bringing the assessment to where people already gather
The setting of a screening event rarely looks like a clinic. A recent event in Tahoka, Texas, took place in a public library, with the team setting up between the stacks. "There are books on both sides," Dr. Singer says, "and we're doing the screening right there." Others have run in senior centers and community halls, wherever the town’s community already gathers.
That improvisation is key to the program's success. "When you start talking about rural health, you have to be innovative," Dr. Singer says. Much of that innovation is about meeting people where they already are, and where they already feel safe. The team returns to the same communities over years, often working alongside a local library, physician, or community health worker people already know and trust.
"These are communities where if you just go there once, you're never going to get people," Dr. Singer says. "They're not going to trust you." Familiar surroundings lower the anxiety that keeps people from getting checked, and the proof is in the turnout: at community bingo nights, hosted by Dr. Singer’s team, he estimates that 80% to 90% of those who come to play also sit down to be screened.
Given the varied assessment settings, the tool has to move as easily as the team does. Because the assessment runs on an iPad and is scored automatically, whoever administers it needs no specialized training, so his doctoral students, undergraduates, and coordinators can all run it. "With 3 of us, we can screen 40 or 50 people in the time it would take to sit 1-on-1 with a handful," he says.
For patients, even a difficult result, Dr. Singer has found, tends to come as a kind of relief. "There's a validation," he says, "of 'I really do need to go see a neurologist,' rather than telling yourself it's just normal aging." For many, the screening puts words to something they had noticed in themselves and quietly set aside.
