CHR Mini-Cog Screening Pilot

Report: Cognitive Screening Tools in a Community Health Setting

Recognizing the critical role of CHRs as trusted, community-based health workers who bridge cultural and geographic gaps in care, the IHS CHR and Alzheimer's Programs conducted a six-month pilot from January to July 2025 to assess the feasibility of CHRs integrating the Mini-Cog© cognitive screening tool into community-based settings. Twenty CHR programs across tribal, federal, and urban sites participated in this second pilot cohort.

Read about the findings in our CHR Project Evaluation Report: Implementation of a Cognitive Screening Tool in a Community Health Setting.

The CHR Mini-Cog Screening Pilot is a multi-year project testing how well the Mini-Cog tool works to screen patients for memory and thinking issues in community settings. The project also helps develop a referral process for individuals needing follow-up care.

Project Goals

The IHS Alzheimer's Program provides funding to support Community Health Representative (CHR) programs to test screenings and other dementia-related services through short-term pilot projects.

The CHR Mini-Cog Screening Pilot is designed to:

• Increase dementia and Alzheimer’s awareness in American Indian and Alaska Native communities
• Build peer-to-peer learning networks for CHRs
• Improve data collection and documentation of screenings

Why Are CHRs Important in Dementia Care?

CHRs play a key role in supporting people with dementia and their caregivers. CHRs can:

• Promote early detection and diagnosis.
• Educate communities about dementia and brain health.
• Connect individuals and families to local resources and support services.

What should people know about CHRs?

• CHR-led cognitive screening works: Community Health Representatives can effectively and appropriately administer the Mini-Cog in community settings, reaching individuals who may not otherwise access care.
• Early identification matters: Screening increases awareness of Alzheimer’s disease and related dementias and helps identify individuals who may benefit from further evaluation and support.
• CHRs are a critical workforce: As trusted community members, CHRs are uniquely positioned to reduce stigma, engage patients, and bridge gaps between communities and the health care system.
• Integration is the next step: The full impact of screening depends on strengthening referral pathways, provider engagement, and CHR–clinical care coordination.
• The model is scalable with support: With appropriate training, resources, and system alignment, CHR-led screening can be expanded and sustained across programs.
• CHR-led screening is feasible and effective: CHRs can successfully deliver cognitive screening in community settings, increasing access and identifying individuals at risk who might otherwise go unrecognized.
• Early detection and awareness are critical: Community-based screening helps normalize conversations about dementia and supports earlier identification and connection to care.
• Stronger integration will maximize impact: Expanding this model requires improved referral pathways, provider engagement, and alignment between CHR programs and clinical care systems.

Progress and Outcomes