EHR-Integrated Screening Workflow Detects Cognitive Impairment at Admission

Cognitive impairment involves difficulties with thinking, learning, memory, and decision-making, and is more common in older adults. In U.S. hospitals, more than 40% of admitted older adults have dementia, yet only about half have a documented diagnosis, leaving many without tailored care. Undetected cognitive issues can adversely affect inpatient management and transitions of care. To help address this gap, investigators have developed an in-hospital screening method to identify previously unrecognized cognitive impairment and dementia among admitted patients.

Cedars-Sinai Health Sciences University (Los Angeles, CA, USA) investigators introduced a comprehensive cognitive screening workflow designed for routine use on general hospital wards. The approach targets patients aged 65 years and older at the time of admission. It was created to be feasible for nursing staff and to integrate into existing clinical processes without requiring specialist oversight at the bedside.

The screening method combines brief, nurse-administered cognitive assessments with an algorithmic decision-support tool embedded in the electronic health record (EHR). The EHR component automatically flags patients whose assessment results suggest cognitive impairment or probable dementia. This flag is visible to the inpatient care team to prompt further evaluation and care planning during the hospitalization.

When implemented across more than 11,000 hospital admissions, the program enabled cognitive screening in over 80% of eligible older adults. Among those screened, the workflow identified previously unrecognized cognitive impairment in 9% and undiagnosed dementia in 4.3%. The analysis also showed that Black patients and those older than 85 years were more likely to be identified as having undiagnosed dementia compared with younger and white patients.

Findings were published in 2026 in the Journal of the American Geriatrics Society. The investigators report that systematic identification at admission can inform inpatient care and discharge planning for vulnerable patients. The work highlights the potential for hospital-based screening protocols, supported by EHR decision tools, to surface cognitive needs that may otherwise go unnoticed.

“Early recognition of cognitive issues is critical to improving hospital care, optimizing outcomes, and proactive discharge planning for cognitively impaired patients, who are at increased risk for falling, behavioral issues and hospital readmission. And yet, cognitive screening of patients remains rare in U.S. hospitals because they lack effective strategies for implementing it,” said Zaldy S. Tan, M.D., MPH, medical director of the Jona Goldrich Center for Alzheimer’s and Memory Disorders at Cedars-Sinai and corresponding author of the study.

“Our screening approach demonstrated the potential to equitably capture cognitive impairment at the point of hospital admission, allowing for interventions to optimize the care for all vulnerable patients,” said Dr. Tan

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Cedars-Sinai Health Sciences University