New Alzheimer’s Association guidelines: How do physicians assess cognitive impairment?
Effective January 1, 2011, the Affordable Care Act (the health care reform law) added a new Medicare benefit, the Annual Wellness Visit (AWV). The AWV is like a check-up or physical exam. Physicians are required to include assessment for cognitive impairment as part of the AWV.
Since as many as half of all Americans living with Alzheimer’s disease have not been diagnosed, the AWV cognitive assessment is a great opportunity to provide millions of people earlier detection of dementia, potentially earlier treatments, better healthcare management, access to services and the opportunity to make informed financial and care plans.
However, when the AWV benefit went into effect, there was no comprehensive guidance to physicians on how to accomplish cognitive assessment. To fulfill this need, the Alzheimer’s Association convened a group of experts who developed recommendations to primary care physicians on how to approach cognitive assessment during the AWV. The workgroup focused on tools that had the following characteristics:
- A brief administration time
- Validated in primary care or community
- Easily administered by non-physician staff
- Relatively free from educational, language or culture bias
- Could be used without payment for copyright
The Alzheimer’s Association Medicare Annual Wellness Visit Algorithm for Assessment of Cognition, released in December 2012, is an effective, practical and easy process that could be used in the primary care setting. Following these recommendations allows clinicians to obtain an objective score that can improve detection of impairment that should be further evaluated.
One study found that structured tools were more effective than physician assessment alone in detecting patients who were later diagnosed with mild cognitive impairment or dementia.
To learn more about the recommendations, visit www.alz.org/physicians or call 800.272.3900.
Your Annual Wellness Visit: What to expect
- Review and update medical and family history
- Review and update a list of current providers
- Routine measurements including height, weight, body mass index (BMI) and blood pressure
- Cognitive impairment assessment
- Review potential risk factors for depression
- Review functional ability and level of safety
- Establish or update a written 10-15 year screening schedule
- Prepare a list of risk factors and conditions for which interventions are recommended or underway, including a list of treatment options and their associated risks and benefits
Assessing for cognitive impairment is now mandated as part of the Medicare Annual Wellness Visit. This offers an unparalleled opportunity for early detection and treatment of dementia. However, physician observation supplemented by reports of patients and informants may be less effective than an objective screening test to achieve this goal.