Date of this Version


Document Type

DNP Project




Cognitive impairment is a medical condition that requires much of the healthcare community's attention. It is a comorbidity that has multiple negative impacts on managing concomitant medical diseases and the health care industry in general. There are at least 5.8 million individuals 65 years and older living with A.D., which will be almost triple by the year 2050. Even though assessment of cognitive impairment has been a part of the Medicare annual wellness visit (AWV) since the implementation of the Affordable Care Act in 2010, cognitive impairment and dementia are under-diagnosed in primary care. According to the Alzheimer's Association Report (2019), primary care physicians state to assess only about 50 percent of patients routinely. A literature review was conducted to determine if an educational intervention in a primary care setting would improve cognitive screening rate and accuracy using the Saint Louis University Mental Status (SLUMS).

The literature review included seven articles from 2015 to 2020 on factors that cause delayed, under-diagnosis, and missed diagnosis of cognitive impairment in primary care. Most of the articles concluded that lack of training and confidence, provider educational needs are significant challenges to cognitive screening. Also, scoring errors is a significant problem that causes delayed and missed diagnosis. However, educational intervention should improve providers' and nurses' knowledge of dementia in primary care and increase timely diagnosis.

The literature review results were used to develop a quality improvement project to improve staff's cognitive screening accuracy, knowledge, and confidence using the SLUMS. The literature review was also used to create an educational intervention, and a pretest and posttest questionnaire was developed to assess the effectiveness of the intervention. A Letter of recruitment was emailed to all potential participants at the primary healthcare clinic. The educational intervention was done virtually using Microsoft teams. The consent, pretest, and posttest were completed via Qualtrics. The data analysis shows an overall improvement in the average scores on the pre-and posttest after completing the educational intervention. In sum, a tool-specific educational intervention can improve cognitive screening rate and accuracy in primary care settings.