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A two-year initiative involving Syracuse University and SUNY Upstate Medical University has found that bringing memory screenings directly into local Offices for the Aging (OFAs) can help identify older adults with early signs of cognitive impairment, but also confirmed that transportation barriers persist. Plus, fear and stigma keep many rural residents from getting a full diagnosis and follow-up care.

The project, led by Maria Brown, associate research professor in Syracuse University’s School of Education, and Dr. Sharon Brangman, director of the SUNY Upstate Center of Excellence for Alzheimer’s Disease, trained 54 case managers and 10 supervisors at seven OFAs across Cayuga, Herkimer, Lewis, Madison, Oneida, Oswego and Tompkins counties. Their training involved administering the Mini-Cog, a brief cognitive screening tool, as part of their routine work with clients.

The project built on an earlier pilot in Onondaga County and was funded by the New York Health Foundation and the Health Foundation for Western and Central New York.

In total, case managers screened 684 older adults. Roughly 35% of those screened had scores suggesting possible cognitive impairment, and case managers referred them for a comprehensive evaluation with geriatricians at Upstate’s Center of Excellence for Alzheimer’s Disease.

Of those referred, 52 ultimately completed the evaluation and only 7 of that group were diagnosed with Alzheimer’s disease. Nearly half were diagnosed with mild cognitive impairment, which is memory changes later in life that do not necessarily lead to dementia but benefit from ongoing monitoring.

“It’s important to draw a distinction that cognitive impairment doesn’t necessarily mean dementia,” Brown says. “For the people we screened, a positive result meant we could connect them with geriatricians for a full evaluation. That’s a chance to get ahead of a problem instead of reacting to a crisis.”

“Early detection gives people and their families more choices,”  says Brangman, who teamed up with Brown on the project. “When we identify memory changes before they become a crisis, we can determine whether it’s Alzheimer’s disease, mild cognitive impairment or another condition, and connect patients with the right treatments, support services and planning resources.”

Many people who were referred for further evaluation chose not to go, and Brown says the reasons point to broader gaps in rural healthcare. Long drives to Syracuse, limited transportation options and fear of an Alzheimer’s diagnosis (including worry about losing independence) all factored into people’s decisions.

Even so, case managers at all seven participating OFAs found the screening valuable enough that they plan to keep using it after the project’s formal funding ends, and providers at SUNY Upstate Geriatrics will continue training new OFA staff on the tool going forward.

“Even when someone can’t or won’t follow up with a specialist, the screening itself gives case managers information they can use to better support their clients,” Brown says. “That’s valuable on its own.”

Brown says the results reinforce the need for more partnerships between medical and social service providers, particularly in rural areas where residents already face a shortage of specialists trained to evaluate cognitive changes. She and her Upstate colleagues hope the model along with the training resources developed through the project can eventually expand to more counties across New York state.