Mining EHR data could help physicians uncover signs of dementia earlier

Mining unstructured notes in the EHR could help physicians and nurses more easily recognize signs and symptoms of Alzheimer's disease and other kinds of dementia, according to a new study published in the Journal of the American Medical Informatics Association.

Andrea Gilmore-Bykovskyi, PhD, RN, an assistant professor at the University of Wisconsin–Madison School of Nursing, led a team of researchers from UW-Madison, the William S. Middleton Memorial Veterans Hospital in Madison and Penn State University in State College, Pa., which combed through unstructured progress notes from the EHRs of 343 patients diagnosed with dementia.

The team was specifically looking for words and phrases that could be indicative of a cognitive dysfunction, like "forgetful at times, "increased confusion in the evening," "disoriented and agitated," "limited by confusion" and "finding it hard to find words."

"Ninety percent of the records had notes reflecting one or more of these descriptors of confusion or cognition," Dr. Gilmore-Bykovskyi said in a news release. "They don't all map to the established, standardized language for detection of cognitive impairment, but it's clearly about cognition."

Although dementia is usually diagnosed or tested for in a primary care or memory clinic, it is not usually documented in the patient's EHR. In fact, clinicians are not diagnosing 40 to 60 percent of dementia cases, Dr. Gilmore-Bykovskyi added. Not only is the diagnosis stigmatizing, but racial and ethnic minorities often have less access to care and are more likely to go straight to the emergency room for medical treatment.

The study's findings suggest  flagging these key terms in the EHR may improve treatment rates for patients who may not have received a diagnosis. It could also propel Alzheimer's and dementia research.

"We need more mechanisms to catch people (and their biological children) early. If there's ever going to be a solution to Alzheimer's disease, that's where it's going to happen, because we know the disease starts decades before anybody has clinical symptoms,"  Dr. Gilmore-Bykovskyi said.

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