{"doi":"10.1038/s41591-024-03012-8","title":"Non-literacy biased, culturally fair cognitive detection tool in primary care patients with cognitive concerns: a randomized controlled trial","abstract":"Dementia is often undiagnosed in primary care, and even when diagnosed, untreated. The 5-Cog paradigm, a brief, culturally adept, cognitive detection tool paired with a clinical decision support may reduce barriers to improving dementia diagnosis and care. We performed a randomized controlled trial in primary care patients experiencing health disparities (racial/ethnic minorities and socioeconomically disadvantaged). Older adults with cognitive concerns were assigned in a 1:1 ratio to the 5-Cog paradigm or control. Primary outcome was improved dementia care actions defined as any of the following endpoints within 90 days: new mild cognitive impairment syndrome or dementia diagnoses as well as investigations, medications or specialist referrals ordered for cognitive indications. Groups were compared using intention-to-treat principles with multivariable logistic regression. Overall, 1,201 patients (mean age 72.8 years, 72% women and 94% Black, Hispanic or Latino) were enrolled and 599 were assigned to 5-Cog and 602 to the control. The 5-Cog paradigm demonstrated threefold odds of improvement in dementia care actions over control (odds ratio 3.43, 95% confidence interval 2.32-5.07). No serious intervention-related adverse events were reported. The 5-Cog paradigm improved diagnosis and management in patients with cognitive concerns and provides evidence to promote practice change to improve dementia care actions in primary care.ClinicalTrials.gov: NCT03816644 .","journal":"Nature Medicine","year":2024,"id":430415,"datarank":0.7709774733817969,"base_score":2.995732273553991,"endowment":2.995732273553991,"self_citation_contribution":0.4493598410330987,"citation_network_contribution":0.3216176323486983,"self_endowment_contribution":0.4493598410330987,"citer_contribution":0.3216176323486983,"corpus_percentile":null,"corpus_rank":null,"citation_count":19,"citer_count":16,"citers_with_citation_signal":11,"citers_with_endowment":11,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9513,"is_data_producer":true,"deposit_databanks":{"ClinicalTrials.gov":["NCT03816644"]},"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1233415,"name":"Rachel Chalmer","orcid":"0000-0001-6394-6539","position":1,"is_corresponding":false},{"id":1206067,"name":"Marnina Stimmel","orcid":"0000-0001-8880-4510","position":2,"is_corresponding":false},{"id":280513,"name":"Erica Weiss","orcid":"0000-0002-0726-7547","position":3,"is_corresponding":false},{"id":782695,"name":"Jessica Zwerling","orcid":"0000-0003-3286-3225","position":4,"is_corresponding":false},{"id":1233416,"name":"Rubina Malik","orcid":"0000-0002-9460-3157","position":5,"is_corresponding":false},{"id":1233756,"name":"David Rasekh","orcid":null,"position":6,"is_corresponding":false},{"id":1233417,"name":"Asif Ansari","orcid":"0009-0002-6176-615X","position":7,"is_corresponding":false},{"id":425661,"name":"Roderick A. Corriveau","orcid":"0000-0002-6954-9240","position":8,"is_corresponding":false},{"id":1233757,"name":"Amy R. Ehrlich","orcid":null,"position":9,"is_corresponding":false},{"id":251474,"name":"Cuiling Wang","orcid":"0000-0001-7806-1928","position":10,"is_corresponding":false},{"id":280512,"name":"Emmeline Ayers","orcid":"0000-0002-5061-3708","position":11,"is_corresponding":false},{"id":280515,"name":"Joe Verghese","orcid":"0000-0003-4252-2547","position":0,"is_corresponding":true}],"reference_count":58,"raw_metadata":null,"created_at":"2026-07-19T01:59:16.092672Z","pmid":"38834847","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}