How PCPs can get ahead of their patients’ cognitive decline

In less than 15 years, the number of people aged 65 or older in the US is expected to rise to 80 million, from less than 55 million in 2019, according to the US Census. Unfortunately, the life years gained are often associated with health-related disabilities. As part of the UN Decade of Healthy Aging (2021-2030), there is a global push to promote healthy aging and add life to years.

Neurological diseases, such as stroke, Parkinson’s disease, and dementia are the leading causes of disability worldwide. The WHO estimates that brain-related disabilities will account for half of the world’s economic burden by 2030. Dementia is the most feared disability in the US and Alzheimer’s disease is the most common form of dementia. Currently, more than 10% of people age 65 and older and about one-third of people age 80 or older have Alzheimer’s disease, according to the Alzheimer’s Association. Promoting brain health is also important life for years.

Unfortunately, the current state of mental health care is too late, failing to promote brain health and prevent or reduce the effects of brain-related disabilities. To reduce the development of the disease and control the development of complications, the following should be followed:

The current approach to brain health is conservative and little attention is paid to preventing cognitive decline and promoting cognitive resilience. Mental health care is often prioritized only when the patient or family member expresses concern, which delays recognition and reduces the opportunity for intervention, especially due to the reluctance of patients to express concerns (for example, due to stigma). A method for screening heart health or screening for cancer shows the power and promise of an alternative, more focused approach to brain health.

Primary Care Providers (PCPs) face barriers to routine screening.A recent survey by the Alzheimer’s Association found that almost all PCPs (96%) think it is important to screen patients 60 and older for cognitive impairment, but only half (48%) currently screen them. Among the main barriers, 72% of PCPs said they have difficulty distinguishing pathological cognitive impairment from normal aging and 47% said they lack the expertise to diagnose it. PCPs also report that they lack access to cognitive tests and resources and time to administer them. Taken together, PCPs lack the tools to screen and monitor patients for cognitive impairment at this time.

Limited availability of specialized diagnostic equipment leads to delays in initiating care plans. Unfortunately, there is a huge shortage of specialists which often results in waiting three to nine months to see one. Many patients would not need a referral to a specialist if PCPs were prepared to provide medical care, especially for patients with dementia and other brain diseases.

Early detection of cognitive impairment and certain diseases, such as Mild Cognitive Impairment (MCI), offers several opportunities to benefit individuals and their families:

Impact trajectory of knowledge through life and health-related processes. Research shows that keeping the brain functioning and building cognitive strength is a lifelong task. A growing body of evidence also shows that strategies to help manage problems that can be changed, such as obesity, hearing and/or vision loss, nicotine use, high blood pressure, high cholesterol, mood disorders, side effects of medications, poor diet, sleep disturbances, inactivity exercise, and/or loneliness can help reduce the risk of cognitive impairment and the progression of dementia (see Lancet Commission 2020, CHALA study 2015). Encouragingly, in the 2022 Lifebrain survey, 70% of respondents said that a memory problem would be the most motivating factor to change their lifestyle (led by their care team). These results emphasize the importance of putting more emphasis on prevention and implementing individualized interventions as soon as possible.

Organize what is most important. Early diagnosis empowers patients and their families to define their future goals and plan for them (eg, living the life they choose based on what is most important to them). An Alzheimer’s Association survey found that 85% of US adults would like to be diagnosed early if they have AD, citing their top two reasons as being able to plan with their families and getting help early (both 70%).

Get timely care and access to medical tests. Clear and early diagnosis helps ensure that treatments can be instituted much earlier, at a time of opportunity when significant change is possible. It also gives patients time to consider enrolling in clinical studies, which allows researchers to track them over time and develop targeted strategies for new clinical outcomes.

PCPs are equipped to partner with individuals and their families to promote brain health, identify cognitive impairment early, and ensure that resources are tailored to the needs of each patient. To do this, PCPs need new tools. Fortunately, the nature of knowledge assessment is growing rapidly as technology advances, adoption of older technology increases, and external events – as demonstrated by the COVID-19 pandemic – encourage creativity.

There are several limitations to traditional data analysis tools. Paper-based assessments require a manual approach, involve scoring and interpretation, and provide limited information about a person’s cognitive abilities, making them ineffective or dangerous. In addition, large neuropsychological batteries are required to be validated and the process of using these tests and obtaining results can be time-consuming and, therefore, can cause unnecessary delays in making clinical decisions.

Digital information analysis is creating a new environment for rapid assessment and intervention in primary care. AI-assisted evaluation that evaluates performance on multiple variables and analyzes various metrics provides predictive and real-time insights, identifying subtle signs of cognitive impairment in preclinical AD and MCI subtypes. These devices are also highly effective, can be easily integrated into primary care practices, and do not require physician supervision. Accurate scoring and immediate interpretation frees up time for PCPs to monitor the patient’s next steps, which other digital solutions also help to support clinical decisions.

Widespread use of digitally-enabled cognitive assessment can benefit patients, providers, and larger healthcare systems. Digital solutions provide value to PCPs by streamlining risk assessment and operational processes, as well as providing new revenue opportunities. It can be effectively integrated into annual well visits, establish a reliable cognitive assessment practice, and can help PCPs take advantage of the new Medicare reimbursement codes for Cognitive Assessment and Care Planning, which have not been used to date. In addition, in a world of high-cost healthcare, adaptive screening offers the potential to help prevent complications that require urgent or emergency care by identifying those at high risk early. By facilitating more comprehensive and effective assessments, digital assessments can help support early and more effective interventions, more effective clinical trials, and more opportunities for patients to participate in clinical trials.

It’s never too late, and it’s never too late, to influence individual mental processes and reduce the risk of brain-related disability and depression in patients. A deeper understanding of new digital brain health screening methods can empower PCPs to help their patients stay ahead of cognitive decline and improve quality of life.

Alvaro Pascual-Leone, MD, PhD is Chief Medical Officer of Linus Health, Professor of Neurology at Harvard Medical School, Senior Scientist at the Hinda and Arthur Marcus Institute for Aging Research, and Medical Director of the Deanna and Sidney Wolk Center for Memory Health in Hebrew SeniorLife.

Ankur Bharija, MD is the Vice President of Geriatrics at Linus Health and an Associate Professor and practice of medicine, primary care and public health, at Stanford University School of Medicine.