“Sweeping changes” are needed to improve the rate of cognitive impairment detection by primary care providers, according to new recommendations from a workgroup of national experts.
Cognitive impairment is a hidden epidemic, substantially underdiagnosed in the United States and especially in underserved populations, reported the group, which includes clinicians, public policy specialists, patient advocates and representatives from the healthcare industry. Instituting routine, brief cognitive assessments in primary care — an entry point for most patients — is the place to start correcting the situation, they proposed in a new perspective published Wednesday in the journal Alzheimer’s & Dementia.
3 strategies to encourage assessments
The group recommended three strategies to promote the use of brief cognitive assessments in adults aged 65 years and older. These include ensuring primary care clinicians have access to suitable assessment tools; integrating these assessments into routine workflows such as annual wellness visits; and holding payers and health plans accountable by crafting payment policies to encourage adoption.
Brief cognitive assessments also can be available outside traditional office visits, the authors suggested. They foresee expanding use of these tools into home visits, community clinics, and retail stores and pharmacies that provide health services. Data on quality and patient outcomes will need to be tracked as well, in order to develop an evidence base for making assessments a regular practice, they added.
Early, equitable diagnosis
The proposed changes are broad, the authors acknowledged, but urgently needed, they said.
“As our understanding of the biology of neurodegenerative diseases improves and better treatments emerge, concerted efforts from many stakeholders are necessary to identify patients who can benefit from those innovations, and do so in a timely and equitable manner,” they concluded.
In post-acute settings, there is a wide variation in the documentation of cognitive screening and assessments, a study published in February found. Cognitive impairments occur for 30% to 60% of older adults receiving post-acute care, and standardized methods for recording evaluations of cognitive health could help improve care coordination in this industry, that study’s authors wrote.
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