Detection and differentiation of undiagnosed dementia in the emergency department: A pilot referral pathway

INTRODUCTION: Cognitive impairment (CI) is under-recognized by emergency department (ED) clinicians, and processes for cognitive screening and outpatient referrals are limited. METHODS: This pilot study tested the feasibility of ED clinicians referring older adult patients identified through CI screening and direct clinician referral for outpatient cognitive evaluation. Telephone interviews and chart reviews were conducted on 100 patients about their emergency care, cognitive function, and referral status. RESULTS: A total of 9359 ED patients were screened for memory and thinking problems, with 650 (6.9%) reporting such issues. A total of 100 patients were discharged and referred for outpatient cognitive evaluation, consisting of 37 referred from screening and 67 through direct clinician referral. Of these, 26 (26.0%) scheduled and 19 (19.0%) completed outpatient evaluations within 100 days. Fifteen (78.9%) were formally diagnosed with dementia, CI, or memory loss. DISCUSSION: ED clinicians are able to identify and appropriately refer older patients with CI for outpatient evaluation. Future studies can improve referral rates with solutions addressing detection and follow-up challenges. Highlights: Screening for cognitive impairment and outpatient referral for cognitive evaluation is feasible in the emergency department. Nearly 80% of patients who completed follow-up were diagnosed with cognitive impairment, including probable dementia and Alzheimer's disease. Significant gaps and barriers remain in maintaining outpatient follow-up from initial referral from the emergency department, with less than one in five patients completing outpatient evaluations.