Objective:

To assess the association between Medicare annual wellness visits (AWVs) and the early diagnosis of mild cognitive impairment (MCI) and Alzheimer's disease and related dementias (ADRD) in older adults.

Approach:

• Study Design: Researchers recruited 549,516 Medicare beneficiaries in Texas from 2015 to 2022, aged 68 years or older, without prior diagnoses of MCI or ADRD.
• AWV Participation: In 2018, 12.1% (n = 66,433) of participants attended an AWV, which typically included cognitive assessments.
• Statistical Analysis: The study analyzed the likelihood of MCI and ADRD diagnoses associated with AWVs, calculating hazard ratios (HRs) and confidence intervals (CIs).

Key Findings:

• AWVs were associated with a 21% increase in the likelihood of an MCI diagnosis (HR = 1.21, 95% CI = 1.16–1.27).
• AWVs were associated with a 4% increase in the likelihood of an ADRD diagnosis (HR = 1.04, 95% CI = 1.02–1.06).
• Sensitivity analyses showed stronger associations for MCI diagnosis with HRs of 1.36 and 1.40 under different conditions.
• The median time to first MCI diagnosis was 692 days for those with AWVs compared to 768 days for those without.

Interpretation:

Limitations:

• Potential self-selection bias as patients with suspected cognitive issues may have been more likely to attend AWVs.
• Findings may not be generalizable outside of Texas due to its unique demographic composition.
• Reliance on Medicare billing data lacked detail on AWV execution and cognitive assessment management.
• The follow-up period included the COVID-19 pandemic, which may have affected health care utilization.

Conclusion:

Sources:

• JAMA Network Open