Cognitive assessments during Medicare annual wellness visits increases rate of new dementia diagnoses
Jan 22, 2021
population ages, this number is projected to grow to 14 million by 2050 if no significant advances in prevention or treatment are made. Currently no cure exists for dementia and treatment options are limited in their effectiveness. Because of this, screening for dementia is not commonplace, despite the fact that early detection of dementia could allow for more effective treatment.
In 2010, The Medicare Annual Wellness Visit was introduced. This is an annual visit with no copayment available to all Medicare recipients past their first year of enrollment. It focuses on preventive care and includes a required direct cognitive assessment as one of several components. When screening is not conducted regularly, over half of dementia cases are undiagnosed, therefore the introduction of the Annual Wellness Visit could significantly increase the rate of dementia diagnosis in older adults. The purpose of a new study was to examine the association between direct cognitive assessment through the Medicare Annual Wellness Visit and new diagnoses of dementia. Additionally, prior research has found that minority patients are more often diagnosed at later stages of dementia and that nearly half of those with positive screening results do not seek further assessment. The study thus also set out to determine whether any effects in rates of diagnosis differed by race.
The Medicare Limited Data Set 5% random sample from 2003 to 2014 was used for this study. The study included 324,385 fee-for-service Medicare recipients aged 65 between the years 2003 to 2008 with no dementia diagnosis as 2011, when the Annual Wellness Visit was implemented.
Public Health Impact
Richard Lindrooth, Elaine Morrato, Lori Crane, and Marcelo Perraillon from the Colorado School of Public Health, along with colleagues from the Mel and Enid Zuckerman College of Public Health at the University of Arizona and the University of Colorado School of Medicine found that Annual Wellness Visit utilization was associated with an increased probability of new diagnosis of dementia. The effects varied by race and ethnicity - the largest impact was seen among Hispanic/Latino participants, who had diagnosis rates over 6 times higher when utilizing the Annual Wellness Visits.
While the study found that rates of dementia diagnosis did increase with the implementation of the Annual Wellness Visit, the benefits of screening are yet to be determined because of the lack of effective treatment options. As such, the United States Preventive Services Task Force has currently rated dementia screening with an “I” for insufficient evidence to recommend for or against screening.