The use of an App to help improve diagnosis of dementia in Primary Care

The primary care based Dementia Support Team in Swansea in Wales are using an App called CANTAB Mobile to help triage for clinically significant memory impairment. The newly established team covers five cluster networks each with a population between 30,000 and 70,000 and promotes collaboration through the integration of health and social care and other key partners. The team are using the App to expedite appropriate referrals to specialist Memory Assessment Services by ‘screening in’ only those with a clinically significant memory impairment.  This is helping to tackle the issue of poor diagnosis of dementia by encouraging GPs to identify those patients who are at risk and who would benefit from more in-depth cognitive assessment. This development has been delivered through The Bevan Commission’s Health Technology Exemplar Programme and has Cambridge Cognition as its industry partner.  The collaborative partnership has enabled the purchase of multiple use licences for use by Dementia Support Workers who use the App to deliver robust, person-centred triage for memory concerns in the patient’s own home. This ensures faster signposting to the appropriate pathway and represents a significant cost saving and an efficient use of current resources. The CANTAB Mobile is a recognised and highly effective test of cognition and detects changes to memory using a touch-screen i-Pad to show a sequence of abstract shapes. Unlike other paper-based cognitive tests there is no reliance on fine motor skills to draw or write.  Although not diagnostic, the result is easily interpreted and uses a traffic light system in which red highlights clinically significant impairment and is useful in helping to broach the topic of possible dementia with both the family and GP alike.  The test highlights the need for further in-depth cognitive testing and can be used by both qualified and unqualified staff.  The standardised voice-over instructions are available in multiple languages, including Welsh, making it culturally accessible to patients. Access to a robust method of triage is essential in the early identification of dementia and this means that GPs can now action referrals to Memory Assessment Services with confidence.  By screening out unnecessary referrals this can reduce burden on existing resources and is also helping to explore new pathways to diagnosis.                          In summary, the CANTAB rapidly establishes whether memory impairment is clinically significant or not through the early identification of those patients needing referral for more in-depth cognitive testing and those that don’t. A triage assessment for symptoms of depression and level of functional independence are also included within the test which can help signpost patients for treatment other than dementia when indicated. This service improvement is being evaluated as part of a professional doctorate programme at Swansea University and uses action research as the methodology of choice to highlight some of the challenges of overcoming an overtly medicalised approach.  Finally, the use of the App and the development of the Dementia Support Worker role are helping to deliver person-centred triage assessments in accordance with the Bevan Commission’s Principles of Prudent Healthcare.