What the annual physical misses
“The doctor will see some of you now.”
When primary care physicians (PCPs) conduct annual wellness visits, they evaluate their patients’ health using heart, lung, liver, and other major-organ screenings, but they rarely check brain health. Regular screening checks have become a fixture in our culture for early detection and intervention to reduce the risk of and monitor chronic disease. Nearly all PCPs (96%) say it is important to assess patients aged 60 and older for cognitive impairment, yet in a sample survey of adults with either Medicare Advantage (MA) or fee-for-service Medicare, just about a third of those enrolled say they received an evaluation.
Recognizing the unmet need, CMS has taken action, requiring cognitive assessments to be part of annual wellness visits for Medicare beneficiaries. The low number of cognitive screenings conducted shortchanges patients and fails to address the Alzheimer’s crisis that is overwhelming the medical system.
With new medications like Leqembi on the horizon, delaying an Alzheimer’s disease diagnosis by more than a year means patients could miss out on the possibility of receiving life-changing treatment, enrolling in a clinical trial, or participating in care decisions.
It’s widely understood that catching impairment early is key, but four circumstances have suppressed PCPs’ adoption of cognitive screening:
- More than 1/3 of PCPs report not being fully comfortable diagnosing mild cognitive impairment (MCI) and more than one-half say they are not fully comfortable diagnosing MCI due to Alzheimer’s disease.
- Traditional pencil-and-paper exams are time consuming, requiring anywhere from 15 to 45 minutes to administer and score, making it difficult for PCPs to perform them within the ever-shrinking timeframe of an in-office visit. In fact, more than half of PCPs cite lack of time when asked why they aren’t assessing patients.
- Specialists next in line to conduct assessments – neurologists, neuropsychologists, and providers specializing in senior care – are in short supply. For example, the U.S will have to triple the number of geriatricians by 2050 in order to adequately care for the growing 65+ population, which currently includes nearly 6 million people diagnosed with Alzheimer’s and millions more untested and undiagnosed.
At the same time, people really want to know about their brain health. A majority of Americans – 70% – say they would want to know if they had Alzheimer’s disease early if it could allow for earlier treatment. With biomarkers for Alzheimer’s present in the brain up to 20 years before outward signs of decline, early screening and annual monitoring could dramatically change health outcomes. The major obstacle for accessible screening has been time and technology, but that’s changing.
As with the other major-organ tests, digital technology has changed the efficiency of cognitive assessment. My company, Neurotrack, is among the companies using technology to change our approach to brain health. We’ve developed the 3-Minute Cognitive Screening, a first-line, digital tool to help busy primary care teams rapidly identify cognitive impairment. Using a tablet, the screening can be self-administered by patients in the exam room and overseen by a medical assistant, allowing staff to operate at the top of their license. Alternatively, a patient could complete the screening at home, prior to the visit, on any device. It’s scored instantly and objectively, with EMR-ready results for the healthcare provider to discuss right away. This approachable, culturally-agnostic test will, for the first time ever, enable screening at scale.
The other half of the cognitive health challenge – what to do after screening – is also changing. A low score can trigger further workup, while a normal score can kick off an important conversation. Lifestyle and behavior change may boost cognition and reduce Alzheimer’s risk factors. Research into lifestyle factors – including sleep, diet, exercise, mental activity, social engagement and their contribution to cognitive health, including a new study about women – have spurred the emergence of digital therapeutics to encourage healthy habits. That’s why Neurotrack offers a unique health coaching service and expert-vetted educational content to further support patients.
The need for cognitive screening by PCPs at scale is urgent, with an aging population, a critical shortage of specialists, and new symptom spikes stemming from the social isolation many experienced during the COVID-19 pandemic. We know that 1 in 9 seniors may be living with Alzheimer’s disease, but current methods are not capturing the true disease burden. A standardized regimen of regular brain checkups could do for the brain what colonoscopies do for the colon. It’s urgent that we get PCPs informed and enable them to address their patients’ needs with efficient cognitive screening tools.
Through technological innovation, policy reform, and greater patient demand, PCPs are now in a position to integrate a quick brain health check into their practice offerings. The tools finally exist to give them confidence to screen for cognitive impairment within annual wellness visits. Implementing this will enable doctors to see all of the patient, fulfilling the belief that brain health is health.