Cognitive screening results from the Medicare annual wellness visit in a primary care practice [abstract]
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Background: Despite affecting 5.3 million individuals, Alzheimer’s disease (AD) is often poorly recognized by healthcare providers until the moderate-severe stages. Cognitive screening is a potential strategy to better identify patients with undiagnosed or early stage dementia. Although the U.S. Preventative Services Task Force (USPSTF) does not recommend routine asymptomatic cognitive screening, the Medicare Annual Wellness Visit (AWV) provides an opportunity to utilize screening methods to identify populations with undiagnosed cognitive impairment (CI) and therefore, at greater risk for healthcare utilization. Methods: All patients undergoing cognitive screening with the MiniCog (MC) during a primary care Medicare AWV were identified. Data from the 18 months preceding screening were collected from the electronic medical record and included the MC score (0-5), demographics, healthcare utilization and presence of chronic disease (diabetes, hypertension, or hyperlipidemia). A MC score <4 was defined as screening positive for CI. Data analysis consisted of Poisson regression and normal mixed effects regression. Results: A total of 5,084 patients (mean age 72.5 years; 46% male) underwent the MC during the AWV and 16.9% screened positive. Relative to those with normal MC scores, patients screening positive showed higher incidence rates of ER visits (80%), inpatient hospitalization (47%), and cancelled appointments (30%) during the 18 month preceding screening. The rate of MC screen positive was higher in diabetics compared to the non-diabetics (p¼0.043). In addition, a greater number of hypertensive patients screened positive on the MC compared to the non-hypertensives (p¼0.007). Finally, MC screen positive rate did not vary between populations with and without hyperlipidemia (p¼0.485). Conclusions: The MC screen positive rate from the AWV was consistent with previous findings from the literature. Patients screening positive on the MC showed higher rates of healthcare utilization compared to those screening negative during the 18 months preceding MC administration. Hypertension and diabetes were associated with a greater risk of CI as detected by the MC. The AVW provides an unprecedented opportunity to identify early stage CI as well as patient populations at risk for higher healthcare utilization.