One in six individuals aged 65 and older in the United States experience mild cognitive impairment, yet this condition remains significantly underdiagnosed, particularly among disadvantaged populations.

The Brief Cognitive Assessment Work Group, a collaborative effort led by the non-profit organization UsAgainstAlzheimer’s, comprises 15 professionals including clinicians, researchers, and health systems administrators from various regions across the U.S. The primary objective of this group is to advocate for the early detection of cognitive impairment, benefiting both patients and caregivers. Timely diagnosis enables individuals to plan for future care, take preventive measures to potentially delay certain symptoms, and identify cognitive impairment resulting from treatable conditions.

To address the widespread and equitable utilization of brief cognitive assessment tools in primary care, the expert panel has issued a set of recommendations for policymakers and payers. These guidelines, which aim to promote the adoption of such assessment tools, have been published in Alzheimer’s & Dementia, a peer-reviewed journal of the Alzheimer’s Association.

Dr. Nicole Fowler, a member of the work group and a research scientist at the Regenstrief Institute, as well as a faculty member at the Indiana University School of Medicine, emphasized that researchers and other experts have spent the past 15 years studying the benefits and risks associated with early detection of cognitive impairment. Their findings have demonstrated the potential benefits of early detection without causing distress to patients. While certain policy changes, such as including cognitive impairment screening in the Medicare Annual Wellness visit, have encouraged detection in primary care, specific guidance on implementation has been lacking for healthcare providers.

The work group emphasizes the promising potential of incorporating brief cognitive assessment tools into routine practice to enhance the detection of cognitive impairment. Although these tools are not diagnostic, they serve as valuable aids in identifying patients who require comprehensive cognitive evaluations. The expert panel acknowledges that brief cognitive assessments can overcome certain challenges encountered by more comprehensive assessments, such as time constraints during medical appointments and inadequate clinician training.

Dr. Fowler explains that the purpose of the paper was to provide specific guidance on the necessary requirements for implementing such assessments within the healthcare system. For instance, the paper explores the availability of user-friendly tools that facilitate cognitive impairment detection in primary care and can be seamlessly integrated into existing workflows. Additionally, it addresses the potential for clinicians and healthcare systems to receive reimbursement for conducting screenings for mild cognitive impairment.

To tackle these obstacles and various other challenges, the expert panel proposes the following recommendations:

• Integration of brief cognitive assessments into the standard workflow of primary care practices with the assistance of support team members.
• Collaboration with professional societies, healthcare systems, and other stakeholders to create comprehensive guidelines for effective clinician-patient communication regarding cognitive discussions.
• Configuration of electronic health records within health systems to include provisions for incorporating brief cognitive assessments.

Approximately 15 percent of individuals with mild cognitive impairment are likely to progress to dementia within a span of two years. By the year 2030, almost 40 percent of Americans affected by Alzheimer's will be from Black or Latino communities. Furthermore, projections indicate that the number of Americans living with Alzheimer's disease will reach 12.7 million by 2050.

The conclusion drawn from the perspective paper titled "Expanding the use of brief cognitive assessments to detect suspected early-stage cognitive impairment in primary care" highlights the grave consequences of neglecting the detection of cognitive impairment, resulting in a concealed epidemic. With advancing knowledge of neurodegenerative disease biology and the emergence of improved treatments, collaborative efforts from multiple stakeholders are imperative to identify patients who can benefit from these innovations promptly and equitably.

UsAgainstAlzheimer's has provided funding to facilitate the consensus-building process of the expert panel and support the development of the perspective paper.