Abstract Details

Title Care Gaps and Opportunities in Primary Care for Early Identification of Mild Cognitive Impairment.

Topic Aging, Dementia, and Behavioral Neurology

Presentation(s) P2 - Poster Session 2 (11:45 AM-12:45 PM)

Poster/Presentation
Number 13-005

Objective To identify gaps in primary care in identifying, evaluating, and referring patients with MCI to neurology in a large integrated health system.

Background Early diagnosis of MCI is paramount in this new era of disease-modifying therapies for Alzheimer’s dementia. Primary care physicians (PCPs) are the first point of contact for patients with memory loss, however rates of diagnosis, and referral to Neurology for MCI remain understudied.

Design/Methods We conducted a retrospective study using electronic health records, to identify patients aged ≥65 years evaluated by PCP between 2021-2024 with incident (first time) diagnosis of memory loss (R41.3) or MCI (G31.84. We excluded patients with an established diagnosis of dementia, vascular and Parkinsons dementia. We assessed the frequency of cognitive tests, screening labs (B12, TSH), brain imaging (CT, MRI), and referrals to neurology. We also assessed any disparities in gender and race/ethnicities.

Results

Among 294,731 primary care patients aged ≥65 years, 19,656 (6.7%) had incident diagnosis of memory loss and 7,039 (2.3%) had MCI. The incidence was higher for females at 7.1 % (vs 6.1 % in males) and blacks at 7.4% compared to other ethnicities.

19.1% received MMSE and 0.7% MOCA by PCP. TSH was ordered in 73.4%, B12 in 50%, with rates slightly lower for Blacks (54 and 45.2% respectively). Brain imaging was ordered in 35%. 31.6% received a referral to neurology, with slightly higher rates for Asians (41.1%) and Blacks (38.5%) with p value = 0.001.

Conclusions

These data show lower diagnostic incidence rates of MCI relative to the expected actual incidence of 10-20% ≥65 years.

Further studies to understand barriers to detect MCI in primary care are needed. Solutions such as outreach/education, standardized screening and care pathways, and improved access to neurologists are critical to ensure timely evaluation of MCI in order to optimize disease modification and delay progression to dementia.

Authors/Disclosures
Minal Bhanushali, MD (Palo Alto Medical Foundation) PRESENTER	Dr. Bhanushali has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eli Lily. Dr. Bhanushali has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Eisai. Dr. Bhanushali has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Topline LLC. The institution of Dr. Bhanushali has received research support from Eli Lily.
Han Yan, MD, PhD	Dr. Yan has received personal compensation for serving as an employee of Stanford University.
Lisamarie B. La Vallee, RN, DNP	Miss La Vallee has nothing to disclose.
Qiwen Huang, Sutter Health	Ms. Huang has nothing to disclose.
Pragati Kenkare, MS	Mrs. Kenkare has nothing to disclose.
Nick Romero	Mr. Romero has nothing to disclose.
Peter Ro, MD	The institution of Dr. Ro has received personal compensation in the range of $0-$499 for serving as a Consultant for Eli Lilly.
Shawn Kile, MD	Dr. Kile has nothing to disclose.
Armen J. Moughamian, MD, PhD (Ray Dolby Brain Health Center)	Dr. Moughamian has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biogen. Dr. Moughamian has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Eisai. Dr. Moughamian has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Eli Lilly. Dr. Moughamian has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ferrer. Dr. Moughamian has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genetech. Dr. Moughamian has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Corium. Dr. Moughamian has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Biogen. Dr. Moughamian has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Eli Lilly. Dr. Moughamian has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Pillsbury and Coleman.

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