Drs. David Weisman, John Khoury, and Kandan Kulandaivel from Abington Neurological Associates, a community neurology clinic, with support from Abington Memorial Hospital's Innovator's Circle grant, have developed an iPad app. The Philadelphia cognitive assessment (P-Cog) is cognitive test to diagnose and detect Mild Cognitive Impairment (MCI) vs. Dementia and can be done within four minutes by clinical providers. It all began one day when three neurologists, at the end of a long clinic day, were discussing the reasons of why cognitive disorders in general are under-discussed and under diagnosed. Of the many reasons identifying and discussing Alzheimer's disease is time consuming and and thus penalizes doctors who have real discussions with their patients. In the current healthcare atmosphere, we all know the pressures faced by primary care and non-procedural physicians. We all know the facts. Doctors get paid disproportionately more to do procedures and read scans and less to listen and think, diagnose and deliver news. Medicare seems to have put the 96120 code in place to reduce some of these barriers. We began exploring this and found out that we needed a computerized cognitive test with a doctor's interpretation and report. We all already do this in Paper but we needed a computerized test.
Weirdly, there was no good test on the market that we felt comfortable using. Despite the rise of EMR's, they have failed to provide user-friendly solutions to this problem, and they are ugly and difficult, very much at odds with the rest of technology surrounding us, with their beauty and intuitive feel.
So we set to work on developing an iPad app. We arrived at a 30 question, multi-domain test which takes 2-4 minutes to complete. It is designed to be 'memory-heavy' to capture the most common form of mild cognitive impairment, amnesic. It also tests expressive and receptive language, logic, executive, math and visual spatial domains. We found it to be user friendly, intuitive, and even fun for the patient to take with patient interactions as well. Since all 3 of us love Philadelphia, we named it the P-Cog- Philadelphia cognitive testing.
The score, out of 30, correlates to a menu of possible action plans. For example, in a patient who scores 29, one might want to reassure the patient and recommend exercise. In a patient who scores 3, one may opt to discuss end of life care. Or not. The menu allows for a wide variety of action plans. The final report can be printed out and added to the patient's chart.
Abington hospital Innovator Circle grant
MoCA team and Dr Ziad Nasreddine, Neurologist, MoCA© Copyright Owner (CEDRA)-Center for Diagnosis and Research on Alzheimer's disease
Patrick Sleiman, Deepa Amberker MD, Lori Ferro, Sean Patrowich and Swamynathan Chellappan
We also thank all those unnamed peers who criticized our App. You were also our motivation to make our App a success.