Catching Cognitive Decline Sooner

UTMB researchers unite across three schools to improve early detection of memory loss through Medicare wellness visits

When Dr. Yong-Fang Kuo analyzed Medicare data from more than 2 million older adults, the results revealed a striking pattern: those who received annual wellness visits were significantly more likely to receive early diagnoses of mild cognitive impairment—catching memory problems before they progressed to full dementia.

Published in January in Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring, the study found that Medicare beneficiaries who received an annual wellness visit were 13% to 21% more likely than those without a visit to be diagnosed at the mild cognitive impairment stage versus the dementia stage, with the visits reducing—but not eliminating—racial and ethnic differences in early diagnosis.

Medicare Data Analysis Shows Earlier Detection Patterns

First announced in 2023, the $2.8 million grant from the National Institute on Aging supports a five-year project examining how Medicare Annual Wellness Visits—free preventive care visits that include cognitive screening—can improve early detection of memory problems and reduce disparities in diagnosis across different populations.

The research unites expertise from across UTMB: Dr. Kuo leads the quantitative analysis of national Medicare data, Dr. Huey-Ming Tzeng from the School of Nursing conducts interviews with patients and providers, and Dr. Mukaila Raji from the John Sealy School of Medicine provides clinical interpretation and geriatric medicine expertise.

"With such a large sample size from the national data, we can examine whether annual wellness visits reduce disparity in early dementia diagnosis across sex, race and ethnicity, rural and urban residence, and level of education through subgroup analyses," Kuo explained.

The team's initial findings show that wellness visit recipients received their first mild cognitive impairment diagnosis 76 days earlier than those who didn't receive the preventive care—a difference that can be crucial for treatment planning and family decision-making.

Understanding Real-World Experience

While the Medicare data reveals population-level patterns, Tzeng's qualitative research explores what happens during these wellness visits from the perspectives of both patients/caregivers and healthcare providers.

"Using qualitative interview data along with the Medicare data analysis allows for data triangulation for consistency and validity in findings," Tzeng said. Her team is collecting stories from 180 family caregivers and 400 clinicians nationwide to understand what works—and what doesn't—in annual wellness visit delivery for patients with cognitive concerns.

Early pilot interviews with 26 clinicians revealed key insights about recognizing early-stage dementia. "Several primary care providers mentioned listening to patients' and family members' concerns about memory problems and assessing for cognitive and daily function problems during annual wellness visits," Tzeng noted. "If cognitive issues are found, primary care providers may proceed with further evaluation or initiate referrals to geriatrics or neurology specialists."

The interviews also highlighted gaps between policy intentions and clinical reality. Clinicians suggested that dementia diagnosis could be streamlined by encouraging Medicare beneficiaries to utilize annual wellness visits and conducting repeat memory tests to identify problems early. They also emphasized the importance of documenting when family caregivers report early signs of cognitive, functional, or social issues.

Clinical Implications for Geriatric Care

From a clinical perspective, earlier detection through annual wellness visits opens significant opportunities for comprehensive patient care, according to Raji, professor of geriatric and palliative medicine.

"The most important practical implication of earlier mild cognitive impairment detection is the opportunity to prompt clinicians to evaluate patients for the presence of any of the 14 potentially treatable factors such as depression, undiagnosed diabetes, poor vision and hearing loss that explain 45% of dementia causes," Raji explained.

When clinicians know a patient has cognitive impairment, they can also tailor medical care for other conditions. "When a patient with multiple chronic conditions has co-occurring cognitive impairment, a clinician can tailor, modify and adjust treatment intensity and complexity to the level of severity of cognitive impairment," Raji said. This might include simplifying medication regimens, avoiding drugs that can worsen cognitive symptoms, or increasing caregiver involvement in treatment oversight.

The research also has implications for newly approved treatments. "Another important implication of early dementia recognition after annual wellness visits is the opportunity for patients to be considered for the newly approved disease-modifying anti-amyloid drugs—lecanemab and donanemab, which are approved for only mild cognitive impairment due to Alzheimer's disease or early Alzheimer's disease," Raji noted.

Addressing Health Disparities in Texas

The findings have particular relevance for Texas, which has both a high dementia burden and a rapidly diversifying older population. "Texans' high dementia burdens reflect the high rates of diabetes, obesity, hypertension, and metabolic syndromes—known modifiable risk factors for dementia—especially vascular dementia, which is highly prevalent among older Latinos and Blacks," Raji observed.

The research team found that annual wellness visits had modest but significant effects in reducing sex and racial disparities in early cognitive impairment diagnosis, though disparities persisted. "It is important for clinicians to remind their elderly patients to receive an annual wellness visit, especially men and minorities who have lower rates compared to their counterparts," Kuo emphasized.

Three Schools, Three Perspectives, One Goal

The collaboration represents more than just combining expertise—it demonstrates how different research approaches can strengthen scientific understanding. Kuo's population-level analysis provides the statistical foundation, Tzeng's interviews reveal the human experience behind the numbers, and Raji's clinical expertise ensures the findings translate into actionable medical practice.

As the five-year project continues, the team expects to generate additional insights about how annual wellness visits affect not just diagnosis timing, but also subsequent healthcare outcomes like medication management, advance care planning, and overall quality of care for older adults with cognitive concerns.

"Our findings of annual wellness visit services helping in early recognition and diagnosis of Texans with memory and cognitive decline can inform early implementation of preventative lifestyle and treatment efforts," Raji said. "This can improve patient quality of life, help patients with dementia age in place for as long and as safely as possible, reduce caregiver stress, and reduce overall healthcare costs."