Understanding the Gap in Cognitive Care Planning

As a primary care provider, you're the first line of support for patients who need cognitive care. According to national research, as many as 10% of U.S. patients over the age of 65 are diagnosed with Alzheimer's disease and 22% have mild cognitive impairment. Unfortunately, there's a significant gap when it comes to managing cognitive impairment over a long period of time. Due to this gap, patients are often left with no system or plan to help them track the status of their cognitive function.

What's the solution? There are many paths of treatment, but a cognitive care plan can provide you with the flexibility to suit the specific needs of your patients. It's designed to assist you in tracking a patient's cognitive function while offering strategies to slow its progression and enhance their overall quality of life.

In this article, we’ll discuss what a cognitive care plan is, including what the causes of the cognitive care gap are, common cognitive assessment tools, challenges and benefits, the goals of a cognitive impairment plan, and how the right plan can improve your primary care service, patient experience, and workflows.

What is a Cognitive Care Plan?

Also known as a cognition care plan, it typically refers to a systematic method for diagnosing, managing, and tracking signs of impairment and decline in a patient's cognitive function. There is no one-size-fits-all strategy when it comes to care plans. In fact, care plans should be tailored to address specific neurological diseases and disorders such as Alzheimer's disease, dementia, mild cognitive impairment, cognitive decline, brain injury, and so on.

Usually a care plan for cognitive decline will provide tools such as cognitive assessment and session notes to determine the severity of a specific condition. It will also offer treatment options which depend on the severity of your patient's cognitive impairment. For example, a dementia care plan can help you test a patient's memory and reasoning skills over a long period of time. This allows you to detect cognitive impairment and determine if they are fit enough to make their own medical decisions.

Top 5 Causes of the Cognitive Care Plan Gap

As many as 82% of senior patients and 94% of primary care physicians agree that having a care plan for cognitive impairment is vital. After all, detecting cognitive impairment and diagnosing a brain disease in its early stages can lead to better outcomes, such as slowing down the neurodegenerative process. But, if that's the case, why aren't cognitive assessments a part of routine healthcare?

The infrequency of routine cognitive assessment is partly due to a disconnect, or gap, between patients and their physicians. While there are many factors that have led to this gap, it can generally be broken down into five main causes:

1. A lack of awareness

A survey found that only 47% of primary care providers regularly test patients 65 years and older. These results suggest that there's a lack of awareness among health care providers about the benefits of regularly scheduled cognitive assessment, as well as the detriments that can arise without a care plan. Additionally, 96% of providers aren't aware of what the best cognitive assessment tools are and how to integrate them into their practice.

2. A lack of effective tools

The problem isn't that there's a lack of cognitive healthcare solutions available, rather some assessment tools can only catch severe cases of cognitive decline rather than mild cognitive decline. Screening tools like the Mini-Mental State Examination (MMSE) or the Montreal Cognitive Assessment (MoCA) can't always detect the early signs of cognitive decline. This creates a scenario where patients with early stages of Alzheimer's disease or Parkinson's disease aren't aware of their condition and lack the critical support they need to slow down the progress of their impairment.

When it comes to more detailed cognitive assessment tools, cost is the main prohibitive factor for patients. MRIs and electroencephalogram tests are expensive procedures that can take a lot of time to schedule before providing results.

3. Time-consuming

Thorough cognitive assessment and plan development is a time-intensive process for both patients and physicians. While an individual appointment may be relatively quick, scheduling numerous appointments for each patient can quickly lead to a crowded clinic. And if a patient doesn't report any cognitive impairment symptoms, then coming to the clinic multiple times a year (on top of any pre-existing conditions they have) may seem like a waste of time and money.

4. Not initiated by physician

Seniors expect their health care providers to initiate the discussion on cognitive health. But the reality is that only 26% of elders report their clinicians initiating the conversation. This suggests there's a degree of uncertainty about who should be the one to start the conversation.

In fact, many health care professionals believe that it's up to the patient to talk about their cognitive health, either by reporting on symptoms or expressing their concerns. Because patients think that the topic should be brought up by their physician instead, this creates a disconnect where neither side is starting the conversation.

Good communication is a cornerstone of patient care. Normalizing conversations about cognitive health could help healthcare providers detect cognitive impairment in its earlier stages.

5. Patient resistance

The fact is 57% of physicians have reported that their patients were resistant to the idea of cognitive assessment. Patients may be concerned about how they'll be socially perceived, as there's still a social stigma around mental and cognitive health. Many patients have fears around discovering they have a more severe condition or risk of Alzheimer's disease or dementia. Regardless, the statistics suggest that there's still a significant amount of work that needs to be done to break down the concerns and worries patients may have about cognitive assessment.

Common Cognitive Assessment Tools

There are a wide variety of tools available for testing cognitive function. Many of them are simple paper or computer tests, and are relatively easy to administer. Here are a few common assessments healthcare providers are using today:

• Mini-Cogtm: A simple cognitive impairment screening that combines a memory test and a clock-drawing test.
• GPCOG: A brief cognitive test that's supposed to be administered by a general practitioner, primary care physician, or family doctor.
• IADL Questionnaire: Used to measure a patient’s daily living skills and track improvements or declines in function over time.
• MMSE: Usually administered by pencil and paper, and is used to assess advanced deficits in cognitive functioning.

For a more comprehensive package of common cognitive assessment tools, take a look at the Alzheimer's Association Care Planning Toolkit.

The Challenges of Cognitive Assessments

While cognitive assessment can give you a better idea of a patient's condition, it should be noted that these solutions come with limitations. An occasional pen and paper screening test may only catch severe signs of impairment. Furthermore, infrequent screening may not give you data that's accurate enough to pinpoint which areas of a patient's cognition could be impaired.

On the other hand, a care plan with routine cognitive assessments has the potential to catch early signs of cognitive dysfunction because of its long-term nature. And with the rise of telemedicine, routine cognitive tests can be taken in the comfort of a patient's home. This significantly reduces the time each appointment takes, and removes any travel concerns.

With more detailed cognitive assessment information being gathered over a long period of time, you can more accurately pinpoint signs of cognitive decline and administer the appropriate treatments to enhance a patient's quality of life.

What Are the Goals of a Cognitive Impairment Care Plan?

The goals you and your patient should aim to achieve during the course of a cognition care plan depends on their needs and the severity of their condition. The right care plan can:

1. Help your patient understand the current extent of their cognitive function, such as reasoning, memory, problem solving, and planning.
2. Identify your patient's capacity for independent daily living and decision making capacity.
3. Conduct a safety evaluation to note any safety concerns that may occur as a result of your patient's cognitive condition.
4. Track the medication your patient is currently taking, and flag any high risk medications or side effects that may be associated with them.
5. Offer strategies to improve your patient's overall quality of life, such as adult day programs.
6. Identify community resources for patient and caregiver support, such as rehabilitation services, social supports, support groups, etc.
7. Create an end of life plan or arrange palliative care for late stage cognitive disorders.
8. Provide a structured guide for caregivers when looking after a patient at home.

By choosing one or more of these goals, you'll be able to set realistic expectations with your patient and offer solutions that directly address their current needs.

Final Thoughts: Improving Patient Quality of Life with Cognitive Care

Bringing routine cognitive tests into your primary care practice can offer a variety of benefits to your patients. Through active monitoring via scheduled checkups and assessments, patients can get a better idea about the state of their cognitive health. Additionally, the large amount of data collected over time opens up the possibility of catching early signs of cognitive decline—and potentially more severe issues such as Alzheimer's disease. And if a disease is caught in its early stages, then it's more likely that the treatment your patients are prescribed can slow down its progress and reduce its symptoms.

But understanding the benefits of cognitive care is only the beginning. Learn how to create a cognitive care plan so that it fits the needs of your patients while still being within the limits of your clinic's services. Additionally, finding out how you can get reimbursed for the costs of a care plan and how to use software to enhance your plan will be essential for providing a better patient experience while saving costs.

By building an optimized plan, you'll be proactively providing your patients with a robust support system to manage or track symptoms of cognitive decline—ultimately leading to better patient quality of life and bringing your practice a step closer to closing the cognitive care plan gap.