Using the Integrated Cognitive Assessment (ICA) to improve the efficiency of primary care referrals to memory services

Abstract

AbstractBackgroundExisting primary care cognitive assessment tools are crude or time‐consuming screening instruments which can only detect cognitive impairment when it is well established, impacting carers and patient quality‐of‐life.We initiated the Accelerating Dementia Pathway Technologies (ADePT) study to develop a real‐world evidence basis to support the adoption of the Integrated Cognitive Assessment (ICA), a 5 minute computerised cognitive test that employs artificial intelligence to improve its accuracy, as an inexpensive screening tool for the detection of cognitive impairment and improving the efficiency of the dementia care pathway.MethodPatients referred to memory clinics from primary care General Practitioners (GPs) were recruited. Participants completed the ICA either at home or in the clinic along with medical history and usability questionnaires. The GP referral and ICA outcome were compared with the specialist diagnosis obtained at the memory clinic.The clinical outcomes as well as costing data were used as part of an economic analysis to assess the potential health economic benefits of the use of the ICA in the dementia diagnosis pathway in the United Kingdom.Result87 participants referred to memory clinics were recruited who completed all assessments (40 dementia, 19 mild cognitive impairment, 12 inconclusive, 5 healthy, 3 non‐dementia conditions). From these patients the ICA was able to identify cognitive impairment with a sensitivity of ∼90%.The results of the health economics model, utilising real world data collected from the ADePT study estimates that if the ICA were introduced in a primary care setting then it could result in a cost saving to the health and social care system of approximately £147 per patient over a lifetime horizon (∼£44m of direct costs to the health care system) or £283 per patient if introduced into a secondary care setting.ConclusionThe results from this study demonstrate the potential of the ICA as a screening tool to support accurate referrals from primary care settings to memory clinics. The introduction of disease modifying treatments for Alzheimer’s and dementia will further improve the case for earlier detection of the condition and therefore increase the cost‐effectiveness of more accurate screening using tests such as the ICA tool.