Impact of Medicare annual wellness visit on detection of cognitive impairment is minimal

April 10, 2018, Regenstrief Institute

In the first nationwide study to measure the effect of the Medicare Annual Wellness Visit on early identification of cognitive impairment such as Alzheimer's disease, researchers from the Indiana University Center for Aging Research, Regenstrief Institute and IU Center for Health Innovation and Implementation Science found the visit has only minimal impact on detection of cognitive impairment as well as on subsequent cognitive testing and care.

The large observational study, which used de-identified Medicare data, reported insignificant change in the rate of new diagnoses of Alzheimer's disease and related cognitive impairment as well as in the rate of brain imaging or neuropsychological testing used to diagnosis cognitive impairment. It did, however, identify an increase in the use of laboratory testing for thyroid dysfunction and vitamin B deficiency, which may be used to identify possible causes of reversible causes of cognitive impairment. None of these results varied by gender, race, age, or health status (co-morbidities) of the patient.

The study's first author, Nicole Fowler, PhD, MHSA of the IU Center for Aging Research, Regenstrief Institute and IU Center for Health Innovation and Implementation Science, says that the Annual Wellness Visit is a universally missed opportunity to enhance early detection of cognitive impairment. The new study provides unique insight into the lack of provider-initiated actions to look for potential cognitive impairment during the visit.

"Our study shows that implementing a policy—mandating inclusion of detection of cognitive impairment as one of the required elements of the Medicare Annual Wellness Visit—without guidance on how to implement, means it isn't being done. Brief tools that have been validated in primary care could be employed and coupled with a plan for follow-up if cognitive impairment is suspected, but it does not appear that is being done across the United States.

"Physicians do assess for symptoms and initiate treatment for other conditions that do not have a cure such as heart failure and lung disease," she says. "So why aren't we doing the same for cognitive impairment? For example, learning that a patient is experiencing and is taking a prescription or over the counter anticholinergic medication—a class of drugs which we know are harmful to the brain - could greatly improve an older adult's life."

In January 2011, the Patient Protection and Affordable Care Act added the Annual Wellness Visit as a benefit of Medicare, including a screening for . However, the mandate did not include guidance on implementation.

"One-Year Impact of the Medicare Annual Wellness Visit on Detection of Cognitive Impairment: A Cohort Study" is published online ahead of print in the Journal of the American Geriatrics Society. Co-authors of the study, in addition to Dr. Fowler are Noll L. Campbell, PharmD, MS of the Regenstrief Institute and the IU Center for Aging Research; Gerhardt M. Pohl, PhD; Leanne M. Munsie, BS and J. Scott Andrews, PharmD of Eli Lilly and Company; Noam Y. Kirson, PhD; Urvi Desai, PhD; Erich J. Trieschman, BA, and Mark K. Meiselbach, MS of Analysis Group, Inc. and Malaz A. Boustani, MD, MPH of the Regenstrief Institute, IU Center for Aging Research and IU School of Medicine. Dr. Boustani is the founding director of the IU Center for Health Innovation and Implementation Science.

Explore further: Clinical trial is first to study impact of cognitive impairment assessment in primary care

More information: Nicole R. Fowler et al. One-Year Effect of the Medicare Annual Wellness Visit on Detection of Cognitive Impairment: A Cohort Study, Journal of the American Geriatrics Society (2018). DOI: 10.1111/jgs.15330

Related Stories

Clinical trial is first to study impact of cognitive impairment assessment in primary care

September 1, 2015
Does knowing whether older adults are cognitively impaired affect the treatment they receive from their primary care physician? Does it impact the rate of the patient's cognitive decline?

New guideline: Try exercise to improve memory, thinking

December 27, 2017
For patients with mild cognitive impairment, don't be surprised if your health care provider prescribes exercise rather than medication. A new guideline for medical practitioners says they should recommend twice-weekly exercise ...

Older adults are increasingly identifying—but still likely underestimating—cognitive impairment

January 16, 2018
An increasing number of older adults are reporting cognitive impairment in their families over the past two decades, according to a new study led by researchers at NYU Rory Meyers College of Nursing and East Carolina University's ...

Using anticholinergics for as few as 60 days causes memory problems in older adults

May 7, 2013
Research from the Regenstrief Institute, the Indiana University Center for Aging Research and Wishard-Eskenazi Health on medications commonly taken by older adults has found that drugs with strong anticholinergic effects ...

Report will aid in detecting, diagnosing cognitive impairment

February 6, 2015
A new report from The Gerontological Society of America's Workgroup on Cognitive Impairment Detection and Earlier Diagnosis outlines a course of action for increasing the use of evidence-based cognitive assessment tools as ...

Few skull radiation patients show cognitive impairment

August 8, 2017
(HealthDay)—The majority of patients undergoing skull base irradiation for cancer have no detectable cognitive impairment, but about one-third may have ambiguous results with a self-reporting tool, according to a study ...

Recommended for you

Pregnancy history may be tied to Alzheimer's disease

July 18, 2018
A woman's history of pregnancy may affect her risk of Alzheimer's disease decades later, according to a study published in the July 18, 2018, online issue of Neurology, the medical journal of the American Academy of Neurology. ...

Molecular tracer, seen with PET scan, shows concentrations of abnormal proteins

July 17, 2018
In a small study of military personnel who had suffered head trauma and had reported memory and mood problems, UCLA researchers found brain changes similar to those seen in retired football players with suspected chronic ...

Yale-developed test for Alzheimer's disease directly measures synaptic loss

July 16, 2018
Yale researchers have tested a new method for directly measuring synaptic loss in individuals with Alzheimer's disease. The method, which uses PET imaging technology to scan for a specific protein in the brain linked to synapses, ...

New study highlights Alzheimer's herpes link, experts say

July 12, 2018
A new commentary by scientists at the Universities of Manchester and Edinburgh on a study by Taiwanese epidemiologists supports the viability of a potential way to reduce the risk of Alzheimer's disease.

Practice imperfect—repeated cognitive testing can obscure early signs of dementia

July 12, 2018
Alzheimer's disease (AD) is a progressive, neurodegenerative condition that often begins with mild cognitive impairment or MCI, making early and repeated assessments of cognitive change crucial to diagnosis and treatment.

The 'Big Bang' of Alzheimer's: Scientists ID genesis of disease, focus efforts on shape-shifting tau

July 10, 2018
Scientists have discovered a "Big Bang" of Alzheimer's disease – the precise point at which a healthy protein becomes toxic but has not yet formed deadly tangles in the brain.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.