Medicare beneficiaries who received annual wellness visits had a 21% higher likelihood of being diagnosed with mild cognitive impairment, according to a recent study.
In the study, published in JAMA Network Open, researchers assessed 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. They recruited 549,516 Medicare beneficiaries in Texas from 2015 to 2022, all of whom were aged 68 years or older, without prior diagnoses of MCI or ADRD.
In 2018, 12.1% (n = 66,433) of the study participants attended an AWV. The researchers noted that AWVs typically included cognitive assessments.
They found that receipt of an AWV was associated with a 21% increase in the likelihood of an MCI diagnosis (hazard ratio [HR] = 1.21, 95% confidence interval [CI] = 1.16–1.27) and a 4% increase in the likelihood of an ADRD diagnosis (HR = 1.04, 95% CI = 1.02–1.06) compared with those who did not receive an AWV. Sensitivity analyses demonstrated an even larger association between AWVs and the first diagnosis of MCI. In the sensitivity analysis, the link between AWVs and MCI diagnosis became stronger when AWVs were either censored or analyzed as a time-dependent variable, with HRs of 1.36 (95% CI = 1.28–1.45) and 1.40 (95% CI = 1.32–1.49), respectively.
The median time to receipt of first MCI diagnosis was 692 days among those who had an AWV compared with 768 days among those who did not, a difference of 76 days.
These findings suggested a possible association between AWVs and the early identification of cognitive decline in older adults. AWVs were associated with a 21% increase in the likelihood of an MCI diagnosis and a 4% increase in the likelihood of an ADRD diagnosis, indicating a smaller effect on ADRD detection compared with MCI.
The study highlighted several limitations, including potential self-selection bias, as patients or caregivers with suspected cognitive issues may have been more likely to attend AWVs. The findings may not be fully generalizable outside of Texas because of its unique demographic composition, including high numbers of Black and Hispanic participants and lower AWV participation rates. Additionally, the reliance on Medicare billing data lacked detail on how AWVs were conducted or how cognitive assessments were managed. The follow-up period also spanned the COVID-19 pandemic, which may have impacted health care utilization.
The authors reported no conflicts of interest, and the study was supported by a grant from the National Institute on Aging, National Institutes of Health.