Digital dementia screenings flag half of seniors in primary care settings

A new study published in the Annals of Family Medicine suggests digital cognitive assessments (DCAs) could be a scalable way to identify early signs of Alzheimer’s disease and related dementias (ADRD) in primary care, but success may depend less on the tool, and more on the willingness of physicians to use it.

Researchers at Indiana University implemented the Linus Health Core Cognitive Evaluation in seven diverse primary care clinics and found that nearly half of patients screened had signs of borderline or impaired cognition. Still, fewer than 11% of eligible patients ultimately completed the digital test, highlighting persistent challenges around adoption and workflow integration.

Many positives — and many missed

The study analyzed 17,894 encounters over 12 months, identifying 16,708 visits where patients met eligibility for screening (age 65 or older). Of those, just 1,808 screenings were completed. Another 3,727 patients declined the test when it was offered, while physicians chose not to offer it or deemed the visit out of scope in 55.3% of eligible encounters.

Among the 1,722 unique patients who completed the DCA:

• 44.3% screened as cognitively unimpaired
• 36.5% were borderline impaired
• 13.7% were definitively impaired
• 5.6% had inconclusive results

According to the study’s authors, “Almost one-half of patients scored impaired or borderline of cognitive impairment. Clearly, not all have ADRD, but DCAs have utility for early detection in primary care and could represent the first step of risk identification for patients who could benefit from further assessments, referrals to specialists, disease-modifying therapeutics or other evidence-based care management interventions to improve patient and family caregiver outcomes.”

Despite the high rate of positive screens, new diagnoses were limited: only 2.1% of patients who screened as impaired received a new ADRD diagnosis within 90 days, and 5.1% were diagnosed with mild cognitive impairment (MCI). A small number (2.5%) were prescribed anti-dementia medications.

Barriers to clinical adoption

While patient willingness to complete the test was relatively high — nearly four out of five agreed when offered — the study found substantial variation among clinics and clinicians.

“Clinician engagement was much lower than anticipated, with greater numbers of clinicians declining to have their patients complete a DCA or by establishing workflows that deemed some encounters out of scope for screening,” the authors wrote.

In response to clinician feedback, the study introduced a Brain Health Navigator (BHN) role mid-project to help manage follow-up care for patients who screened positive. Ultimately, 62.7% of impaired patients and 47.6% of borderline patients were referred to the BHN.

The authors noted that, “primary care physicians are ideally positioned to detect cognitive impairment, initiate diagnostic evaluations and implement ADRD risk-reduction strategies. However, PCPs cannot do it all on their own. Health systems, health system leaders, payers, policymakers, professional societies and other stakeholders must be involved to address barriers to implementing cognitive assessments and providing follow-up care.”

Among impaired patients, 36% had a B12 test ordered, 35.6% had a thyroid test and 16.9% underwent brain imaging within 90 days. Referrals to neurology, geriatrics or neuropsychology remained low.

Ultimately, the study concludes that while DCAs are “feasible and able to be implemented as part of routine primary care,” broader adoption will require changes to infrastructure, reimbursement and clinician support.