The Dementia Project: Mini-Cog Implementation

Purpose: The purpose of this project was to increase early identification of patients with cognitive impairment through use of the mini-cog screening tool.

Method: A literature review compared different screening tools for cognitive impairment. The mini-cog was noted to be a highly reliable, efficient, and evidence-based method for measuring cognitive decline. Collaborative effort between nursing, social work, and neuropsychology disciplines in the North Florida/South Georgia (NFSG) Veterans Health System occurred to develop the process. Nurses can screen, perform, and document during a routine visit with veterans. Primary care RNs and LPNs can complete these tasks, as well as enter a consult to the social worker, if warranted for further testing. The social worker will provide recommendations to the primary care provider. The provider will consult neuropsychology, as indicated, for a comprehensive assessment.

Findings: Phase 1: Four RNs at The Villages VA Outpatient Clinic (TVOPC) piloted the mini-cog in their respective teams. Out of a total of 2,366 veterans, 104 (4%) were screened, results: 30 (29%) failed testing; 13 were seen by the neuropsychologist and 8 (27%) were diagnosed with some form of dementia. Phase 2: During the COVID-19 pandemic the project was implemented clinic-wide and 8,338 veteran visits were seen, results: 15 (0.1%) were screened with the mini-cog, 11 (73%) failed the screening, three of the 11 were assessed by neuropsychology and all three, or 27% were diagnosed with a cognitive deficit.

Discussion: A keynote in improving these outcomes is early recognition of dementia. Educating primary care clinicians on the implementation of the mini-cog will reduce negative outcomes related to cognitive decline. TVOPC has improved the process of cognitive screening by promoting awareness to the clinical staff and patients of the symptoms of cognitive deficits. Early diagnosis of cognitive deficits can lead to early access to resources, medication and treatment, and decision-making for life planning and involvement in healthcare decisions. Implementation of the mini-cog screening tool has proven to be of value in identifying patients with cognitive impairment. Subsequently plans are underway to deploy use of this screening tool throughout the NFSG primary care clinics to enhance health outcomes in this patient population.