AI Article Synopsis

  • Early detection of Alzheimer's and dementia through Medicare's Annual Wellness Visit (AWV) can help establish treatment plans and meet future needs for patients and clinicians.
  • A study analyzed data from over 3 million Medicare beneficiaries to see how AWVs affect the diagnosis of cognitive impairment, using statistical methods to account for various factors influencing diagnosis rates.
  • Results showed that while AWVs initially appeared to reduce dementia incidence, they actually increased dementia diagnoses, particularly among Black beneficiaries, suggesting that more widespread AWV usage may improve detection, especially in high-risk groups.

Article Abstract

Introduction: Early detection of Alzheimer's disease and related dementias allows clinicians and patients to prepare for future needs and identify treatment options. Medicare's Annual Wellness Visit (AWV) requires detection of cognitive impairment and may increase dementia diagnosis. We estimated the relationship between AWV receipt and incident dementia.

Methods: Using a retrospective cohort of Medicare Fee-For-Service (FFS) beneficiaries enrolled for at least 3 years from 2009 to 2016 and two-stage least squares, we quantified the relationship between AWV and incident diagnosis of cognitive impairment/dementia, and by race/ethnicity. The county-level change in percent of beneficiaries receiving AWVs was used as an instrumental variable to account for unobserved factors associated with individuals' AWV receipt and diagnosis. Sample included 3,333,617 beneficiaries ages 67 years and older, without dementia at the beginning of the study.

Results: Beneficiaries included 2,713,573 White, 251,958 Black, 196,845 Hispanic, 95,719 Asian, 11,727 American Indian/Alaska Native, and 63,795 of other race/ethnicity. Using ordinary least squares, dementia incidence was -0.79 percentage points (95% CI -0.81 to -0.76) lower for persons receiving an AWV compared to no AWV. Using instrumental variables reversed the direction of the effect: AWV receipt increased dementia diagnoses by 0.47 percentage points (95% CI 0.14 to 0.80), 15% over baseline. AWVs increased diagnoses 2.0 percentage points (95% CI 0.05 to 3.94) among Blacks, 0.40 percentage points (95% CI 0.05 to 0.75) among Whites, but est were imprecise for Hispanics and Asians.

Discussion: Increasing AWV take-up and supporting physicians' performance of cognitive assessment may further improve dementia detection in the population and among groups at higher risk of undiagnosed dementia.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9473487PMC
http://dx.doi.org/10.1002/dad2.12357DOI Listing

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