When Dr. Yong-Fang Kuo analyzed Medicare data from more than 2 million older adults, the results revealed a striking pattern: those who received annual wellness visits were significantly more likely to receive early diagnoses of mild cognitive impairment—catching memory problems before they progressed to full dementia.
Published in January in Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring, the study found that Medicare beneficiaries who received an annual wellness visit were 13 to 21 percent more likely than those without a visit to be diagnosed at the mild cognitive impairment stage versus the dementia stage, with the visits reducing—but not eliminating—racial and ethnic differences in early diagnosis.
"With such a large sample size from the national data, we can examine whether annual wellness visits reduce disparity in early dementia diagnosis across sex, race and ethnicity, rural and urban residence, and level of education through subgroup analyses," said Kuo, chair of the Department of Biostatistics & Data Science at UTMB.
The team's initial findings show that wellness visit recipients received their first mild cognitive impairment diagnosis 76 days earlier than those who didn't receive the preventive care—a difference that can be crucial for treatment planning and family decision-making.
While the Medicare data reveals population-level patterns, Dr. Huey-Ming Tzeng, a coauthor on the paper and a professor in UTMB’s School of Nursing, conducted qualitative research which explored what happens during these wellness visits from the perspectives of both patients/caregivers and health care providers.
Her team is collecting stories from 180 family caregivers and 400 clinicians nationwide to understand what works—and what doesn't—in annual wellness visit delivery for patients with cognitive concerns.
"Several primary care providers mentioned listening to patients' and family members' concerns about memory problems and assessing for cognitive and daily function problems during annual wellness visits," Tzeng noted. "If cognitive issues are found, primary care providers may proceed with further evaluation or initiate referrals to geriatrics or neurology specialists."
The interviews also highlighted gaps between policy intentions and clinical reality. Clinicians suggested that dementia diagnosis could be streamlined by encouraging Medicare beneficiaries to utilize annual wellness visits and conducting repeat memory tests to identify problems early. They also emphasized the importance of documenting when family caregivers report early signs of cognitive, functional, or social issues.
"The most important practical implication of earlier mild cognitive impairment detection is the opportunity to prompt clinicians to evaluate patients for the presence of any of the 14 potentially treatable factors such as depression, undiagnosed diabetes, poor vision and hearing loss that explain 45 percent of dementia causes," said Dr. Mukaila Raji, an author on the paper and a professor and director of the Division of Geriatrics at UTMB. "When a patient with multiple chronic conditions has co-occurring cognitive impairment, a clinician can tailor, modify and adjust treatment intensity and complexity to the level of severity of cognitive impairment.”
The findings have particular relevance for Texas, which has both a high dementia burden and a rapidly diversifying older population. The research team also found that annual wellness visits had modest but significant effects in reducing sex and racial disparities in early cognitive impairment diagnosis, though disparities persisted.
"Our findings of annual wellness visit services helping in early recognition and diagnosis of Texans with memory and cognitive decline can inform early implementation of preventative lifestyle and treatment efforts," Raji said. "This can improve patient quality of life, help patients with dementia age in place for as long and as safely as possible, reduce caregiver stress, and reduce overall healthcare costs."