According to Dr. Sharon Brangman, Director of the Center of Excellence for Alzheimer’s Disease (CEAD) at Upstate Medical University, moments like these aren’t necessarily connected to age-related cognitive impairment. And yet that’s often one of the loaded assumptions. “We live in a very youth-focused society,” she explains. “The first time you lose your car keys, you might think ‘Uh oh, I’m getting dementia.’ It’s a built-in fear that’s hard to overcome.”

To help adults understand their risk for dementia, she and her colleague, Dr. Maria Brown, Associate Research Professor at Syracuse University’s School of Social Work and Aging Studies Institute, developed the Healthy Brain Project, a community-based model using the Mini-Cog® screening tool. An earlier version of the project launched in 2018, and the most recent Healthy Brain initiative was completed in 2025. The 2018 pilot was funded by the Health Foundation, and the 2024-5 project was funded by both the Health Foundation and the New York Health Foundation.

Early screening can facilitate an early diagnosis, which offers the best path for managing Alzheimer’s disease. A person who is diagnosed early still has the capacity to make decisions and identify the priorities in their life. They can prepare themselves emotionally and make plans with their family. Also, when the disease is detected before the onset of symptoms, providers have a better chance of involving the patient in decisions about their own care. “It’s always harder when a patient’s in crisis, and there are limited choices,” says Dr. Brangman.

The 2025 Mini-Cog project focused on training case managers to screen residents 60 years of age and older across central New York. The goal was to create a replicable service model that embeds screening for early cognitive impairment into the case management workflow at seven Offices for the Aging (OFA).

OFA case managers were trained on how to administer the screening tool, consisting of these steps:

• Read aloud a list of three words
• Ask the person to repeat the words back to you
• Ask the person to draw a clock face with certain times on it
• Ask the person to repeat the three words

The entire screening takes about 10 minutes.

Although training could be done online or in person, Dr. Brangman remarked that it was much more effective when completed in person. After learning the steps, staff were encouraged to simulate a screening and role-play with one another as part of their training. They also received background information on Alzheimer’s disease and were told to avoid using terms like dementia, memory loss, or Alzheimer’s when screening someone.

Once a screening was completed, the case manager reviewed the result to determine whether or not to refer the person to Dr. Brangman and Dr. Brown. If the screening indicated a potential risk for developing Alzheimer’s disease or another form of dementia, the person was invited to visit CEAD in Syracuse for a formal assessment and diagnosis.

Across all seven OFA sites, a total of 59 case managers were trained, 684 community members were screened, and 550 received a referral for an evaluation at CEAD. Of that number, 117 older adults initially accepted the referrals and 52 followed through on the referrals they received. Although Dr. Brangman wishes the number of completed referrals could have even been higher, she is proud of the outcome. “We were able to train people who really had no background or skills in dementia, and we got people into our office for care they wouldn’t have gotten otherwise,” she says.

Transportation to and from Syracuse was a barrier for some people, and one reason why they declined the referral. Another reason was fear. Many of the older adults were afraid of being diagnosed with Alzheimer’s disease and then losing control of their life.  “It’s the big bogeyman of getting older,” Dr. Brangman explains. “They think we’re going to sign them up for a nursing home or limit their independence.”

A few decades ago, people were afraid to talk about cancer, let alone screen for it. Today, screenings like Pap tests, mammograms, and even colonoscopies are routine. That’s because we know early detection can save lives, and medical breakthroughs have led to promising new treatments. In fact, most types of cancer are now treatable, and some might even be curable.

Alzheimer’s disease, however, is a different story. There is currently no cure, and the disease takes a great toll on both the person with the diagnosis and their loved ones. Beyond the fear is a basic misunderstanding of the disease itself. Dr. Brown explains, “I think a lot of people conflate dementia with mental illness, and then all the stigma attached to mental illness gets attached to it.”

Family dynamics can add another layer of complexity. Some older people worry that a diagnosis means their adult children will take over their life and make decisions without their input or consent. Their children, in turn, might feel overwhelmed by the prospect of caring for a parent with a debilitating medical condition.

Sara Sunday, Director of the Office for the Aging in Oswego County, oversaw screenings in her community as part of the 2025 Mini-Cog project. After completing the training, case managers proceeded to screen older adults who were already receiving home care, meal delivery, or other services through OFA Oswego. While the average age was 76, a few adults were older than 100. Because many of these clients had mobility issues and other health conditions, the OFA case managers went to their homes to administer the Mini-Cog.

“I think some standout successes were when we opened it up to the community,” Sara says. “These non-case-managed participants had concerns about their memory, reached out for assistance, and wanted to have that initial screen. They truly were seeking answers and wanted to know.”

“Anyone who’s provided care to someone with Alzheimer’s knows that at some point, that person had no more control over where they were or what happened to them. The control was all taken over by the caregivers and the doctors and institutions,” explains Dr. Brown. “People are aware that this could happen to them or to a family member.”

The Mini-Cog tool can facilitate an early diagnosis, which offers the best path for managing Alzheimer’s disease. A person who’s diagnosed early still has the capacity to make decisions and identify the priorities in their life. They can prepare themselves emotionally and make plans with their family. Also, when the disease is detected before the onset of symptoms, providers have a better chance of involving the patient in decisions about their own care.

Dr. Brown would like to see New York State promote early screening for Alzheimer’s disease as part of a public health awareness campaign. The goal would be to reinforce a proactive approach to detecting and treating dementia—and changing a person’s medical situation from crisis management to proactive care.

Both Dr. Brown and Dr. Brangman hope that within a few years, getting screened early will become a normalized practice. They hope that by then, we might even be closer to better treatment options.