review · Journal of Internal Medicine
Primary care serves as the main point of contact for older adults, making it the practical setting for identifying mild cognitive impairment and Alzheimer's disease and related dementias. Relying on medical specialists for diagnosis is unsustainable given the growing ageing population. Recent advancements in brain health prevention strategies, diagnostic instruments, and anti-amyloid treatments now enable primary care clinicians to lead early assessment and intervention. Primary care-focused resources, including cognitive screening tools and educational materials on brain health and lifestyle modification, are under development to streamline this process. Timely detection helps uncover reversible causes of cognitive decline, improves the management of co-existing conditions, and reduces risks such as falls, hospitalisations, caregiver stress, and financial vulnerability. In addition, routine primary care assessment helps address severe healthcare disparities affecting rural, lower-income, and minority groups.
Undetected cognitive decline increases patient vulnerability, caregiver burden, and rates of hospitalisation. Embedding early cognitive assessment into primary care settings makes diagnosis more accessible, supports earlier intervention, and ensures that underserved populations, including rural and lower-income communities, receive timely support to preserve brain health and quality of life.
The findings highlight applications for cognitive assessment tools and patient education resources tailored for primary healthcare providers. The intended users are primary care clinicians and health systems seeking efficient screening mechanisms. Given that cognitive tools and lifestyle education materials are actively being developed to integrate into existing healthcare practice, the pathway appears applied and oriented towards clinical implementation.
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Primary care is the ideal setting for early detection of mild cognitive impairment (MCI) and Alzheimer's disease and related dementias (ADRD), as it serves as the primary point of care for most older adults. With the growing aging population, reliance on specialists for detection and diagnosis is unsustainable, highlighting the need for primary care-led assessment. Recent research findings on successful brain health prevention strategies, AD diagnostic tools, and anti-amyloid treatments empower primary care to play a central role in early detection and intervention. Primary care-focused resources are being developed, including tools for cognitive assessments and materials designed to educate patients about brain health and initiate discussions on lifestyle modifications, thereby making early detection more feasible and efficient. Identifying risk factors early enables providers to implement interventions that can slow cognitive decline and improve outcomes for patients and caregivers. If left undetected and unmanaged, MCI and ADRD can lead to worse outcomes, including increased falls, hospitalizations, financial vulnerability, and caregiver stress. Early detection enables the identification of reversible causes of cognitive impairment, supports the management of comorbidities worsened by cognitive decline, mitigates safety risks, and can preserve quality of life. Importantly, primary care is essential for addressing ADRD-related health disparities that disproportionately affect racial minorities, rural populations, and those of lower socioeconomic status. With a focus on the United States healthcare system, this perspective addresses how implementing early detection practices into primary care can improve outcomes for patients and caregivers, reduce societal burdens, and promote health equity in ADRD care.
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DOI: 10.1111/joim.20098
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