Study Reveals Low Clinician Uptake of Digital Dementia Screening in Primary Care

A recent large-scale implementation study conducted across seven diverse primary care clinics highlights significant challenges in clinician engagement with digital cognitive assessments for Alzheimer disease and related dementias (ADRD). Despite patients showing moderate acceptance, with only 22% refusing screening, cognitive assessments were completed in just 11% of eligible patient encounters, underscoring workflow and systemic barriers in primary care settings. Clinicians declined to offer or deemed assessments out-of-scope in over 55% of cases, reflecting operational tensions in integrating these screenings into routine care.

The 12-month study, led by researchers from Indiana University and partnering institutions, utilized a tablet-based evaluation tool designed to detect cognitive impairment in adults 65 and older during primary care visits. Customized workflows were developed at each clinic, emphasizing pragmatic, real-world conditions allowing both clinicians and patients to opt out. Results showed a notable portion of patients (50%) screened as borderline or impaired, indicating a substantial burden of undetected cognitive issues in the primary care population.

Despite the presence of Medicare annual wellness visit requirements including cognitive screening, actual implementation remains low, partly due to primary care's preparedness and structural capabilities. Follow-up care after impaired assessments varied widely; only a minority of patients received diagnostic tests or specialist evaluations within 90 days, and new ADRD diagnoses were minimal. This disparity points to gaps in post-screening pathways and integration of early detection benefits into primary care infrastructure.

The study's findings emphasize the need for enhanced resources, workflow integration, and systemic adaptations to increase clinician engagement and optimize cognitive screening effectiveness in primary care. With emerging therapeutic options for early-stage cognitive impairment, these pragmatic insights are crucial for healthcare stakeholders aiming to bridge diagnostic gaps and improve dementia care pathways.