Annual wellness visits, cognitive function, and early dementia diagnosis.

BACKGROUND

Diagnosing dementia early optimizes care and enables timely interventions for modifiable contributors. Impact of Medicare Annual Wellness Visits (AWVs) on rate of mild cognitive impairment (MCI) detection remains unclear.

OBJECTIVE

To assess association between AWVs and timeliness of diagnosis of MCI and Alzheimer's disease-related dementias (ADRD), adjusting for factors (not accounted for in prior studies) including education, poverty, residence, serial cognitive measures before and after AWV, instrumental activity of daily living, behavioral factors and non-clinical determinants of health-captured in Health and Retirement Study (HRS) survey database.

METHODS

Data from the Health and Retirement Study (HRS) linked to Medicare claims (2011-2019) were used. Propensity score-matched cohorts (AWV vs. non-AWV) were created for four calendar years. HRS survey-based scores before and after AWVs measured cognitive function. Kaplan-Meier and Cox models were used to estimate the risk of MCI/ADRD diagnoses within two years.

RESULTS

Demographic variables were well-matched (absolute standard difference < 10%). Both groups had similar cognitive decline, but the AWV group had higher cognitive scores before and after AWV than non-AWV group. MCI diagnoses were higher in the AWV group, while both groups had similar time to diagnosis for ADRD, independent of behavioral factors and non-clinical determinants of health.

CONCLUSION

AWVs are associated with earlier detection of MCI, which may guide patient-provider decisions on evaluations for modifiable factors (e.g. physical inactivity, smoking, hypothyroidism, sleep apnea) linked to cognitive decline and subsequent dementia.