# A Stakeholder-Engaged Process to Design and Implement the Assessment of Cognitive Complaints Toolkit for Alzheimer’s Disease (ACCT-AD) in Primary Care

## TL;DR

This paper describes the development and implementation of a cognitive assessment toolkit for Alzheimer's in primary care, emphasizing stakeholder collaboration and practical challenges.

## Contribution

The paper introduces a stakeholder-engaged process for creating a practical cognitive assessment toolkit for primary care settings.

## Key findings

- Stakeholder engagement was crucial for the successful design and implementation of the ACCT-AD toolkit.
- Workflow adaptation and staff training were key challenges in integrating the toolkit into primary care practices.
- The toolkit was valued for its educational value and systematic approach to cognitive assessment.

## Abstract

Dementia is underdiagnosed, particularly in primary care settings where most people receive their healthcare. These is a need for tools to assist with the diagnosis of dementia by primary care clinicians, who greatly outnumber specialists.

To describe the collaborative design process, implementation, and lessons learned when developing a new cognitive assessment tool for primary care settings.

We used an iterative approach to develop, test, and revise the Assessment of Cognitive Complaints Toolkit for Alzheimer’s Disease (ACCT-AD), and used qualitative and survey-based methods to identify lessons learned from its use in four community primary care practices in California

Lessons learned from implementing the ACCT-AD toolkit in community primary care practices include the importance of stakeholder engagement in the process, assessing and adapting workflow, staffing, and approach; the educational value of the toolkit as a systematic tool, user response to the toolkit, and challenges around workflow, integration, and sustainability.

The design and implementation of the ACCT-AD toolkit explicitly target workforce constraints that will continue to emerge as demand for cognitive assessment increases. Our approach, which enables primary care clinicians to complete a thorough assessment within their practice, supports building on the strong foundation of the doctor-patient relationship in primary care, and can lead to earlier diagnosis and more efficient referrals.