Barak Gaster, MD, on Practical Approaches to Identifying Cognitive Impairment for Early Intervention

In this video, Barak Gaster, MD, recaps his presentation on identifying mild cognitive impairment for the primary care provider from our 2020 Practical Updates in Primary Care virtual series. 

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Barak Gaster, MD, is a professor of medicine from the Division of General Internal Medicine at the University of Washington.


Barak Gaster: This is Barak Gaster. I'm a professor of medicine at the University of Washington. I am a primary care doctor here, working in general internal medicine. And so I really have been focusing, really for years now, on creating curriculum for primary care that is by primary care for primary care on how to identify mild cognitive impairment and and diagnose early stage dementia in the primary care setting.

My session really is a very practical, nuts and bolts, efficient and practical approach that really gets into the nitty gritty of the evaluation of cognitive impairment in the primary care setting, has really two main components.

So first you want to really get down into a detailed assessment of what are the reversible changes that you could make to identify changes in cognition and make them better. But then, even more importantly, is really getting input from family members. Because even the very best experts in dementia are not very good at assessing and evaluating cognitive impairment without the input from an observer. So somebody who spends a lot of time with that patient.

And so how can we do that in primary care and then really in a very specific way, how can we evaluate cognitive function in primary care? And so really learning how to do a Montreal cognitive assessment test, a MoCA test. It's easy. It's simple. It's practical, and it's so important for us to do.

And then putting those two things together, the observer input and the cognitive assessment, really can allow us to make a diagnosis of mild cognitive impairment or early stage dementia. And then really, we need to develop good solid ways of how do we talk to patients about that, where we're balancing the potential harm that we can do by making people too worried and freaked out. But also, we don't want to minimize it and overly reassure them. We have to find the right balance, how to talk about that, where we're able to intervene early in making changes and how much alcohol people drink, how much other medicines that might be harming them like Ambien might be happening, how much hearing loss might be interfering with people's appearance of cognitive impairment, and then how do we follow people over time with a serial measurements of a MoCA test every six months or 12 months until the diagnosis is more solid and clear.

So I want to thank you. If you are planning to or have already seen my session and you know, this is really a very important, solid way that we can make our lives in primary care, better. But really, most importantly, make the lives of our patients better by identifying cognitive impairment in its early stages. So thank you very much.