MyCog Trial

Title:

Primary Care Detection of Cognitive Impairment Leveraging Health and Consumer Technologies in Underserved Communities: The MyCog Trial 

Dates:

September 2022- August 2027

Funding Source:

National Institute of Neurological Disorders and Stroke (NINDS) 

Grant Number:

U01NS105562 

Background:

Cognitive deficits and impairment, including Alzheimer’s disease and related dementias (ADRD), are highly prevalent among older adults - with higher rates among Black and Hispanic/Latino individuals - and have devastating consequences to families and entire communities. Responding to increasing calls for early detection of cognitive impairment in everyday clinical settings, our trial will offer primary care providers serving affordable, scalable means to detect and care for those affected, while also addressing known disparities. 

Abstract:

Early identification of cognitive impairment (CI), including Alzheimer’s disease (AD) and related dementias (ADRD), is a top public health priority. Yet in primary care settings that manage the health of the majority of community-dwelling older adults, less than half of patients with any CI are detected and/or diagnosed. Among community health centers that serve marginalized patients - by low socioeconomic status (SES), minority race or ethnicity - rates of detection may be far lower. This is of great concern, as Hispanic/Latino (H/L) and Black older adults are 1.5 to 2 times more likely to develop ADRD and to go undetected/undiagnosed compared to non-H/L Whites. Practical, scalable strategies are needed to help primary care practices better detect and manage CI, especially those caring for medically underserved, low SES communities. 
Since 2017, our team has been a member of the NINDS DetectCID Consortium; a network dedicated to improving clinical paradigms for early detection of CI and ADRD and its subsequent management in everyday clinical settings. Having developed the NIH Toolbox for Assessment of Neurological and Behavioral Function (Co-I: Gershon, MPI: Nowinski) and with expertise in health system re-design for patient-centered care (MPI: Wolf), we validated our own clinical paradigm, known as MyCog. This includes a brief, iPad-based, self-administered, electronic health record (EHR)-linked strategy to assess for CI during primary care visits when concerns are identified. We will partner with a national primary care provider (Oak Street Health) and conduct a 2-arm, clinic-randomized, pragmatic trial comparing MyCog to usual care. We will focus on populations experiencing CI/ADRD disparities: Black, H/L, and low SES older adults. 
Our specific aims are to:

1. test the effectiveness of the MyCog paradigm to improve early detection of cognitive impairment and dementias among low SES, Black and Hispanic older adults;
2. determine the fidelity of MyCog and identify any patient, caregiver, clinician, and/or health system barriers to its optimal, sustained implementation;
3. assess the cost-effectiveness of the MyCog paradigm from a primary care perspective; and
4. investigate the presence of disparities in early detection, diagnosis, and rate of referrals by race and ethnicity. 

Impact:  Our findings will address known disparities and offer new evidence on a comprehensive, EHR-enabled, billable, scalable, primary care protocol for early CI detection - informing future, widespread dissemination efforts.  

ClinicalTrials.gov identifier:

NCT05607732 

Contact

• Principal Investigator: Michael S. Wolf, PhD MPH, Cindy Nowinski, MD PhD
• Project Lead: Morgan Bonham