Detection Rates of Mild Cognitive Impairment in Primary Care for the United States Medicare Population
Open accessAbstract
BACKGROUND: Existing evidence points to substantial gaps in detecting mild cognitive impairment in primary care but is based on limited or self-reported data. The recent emergence of disease-modifying treatments for the Alzheimer's disease, the most common etiology of mild cognitive impairment, calls for a systematic assessment of detection rates in primary care. OBJECTIVES: The current study aims to examine detection rates for mild cognitive impairment among primary care clinicians and practices in the United States using Medicare claims and encounter data. DESIGN: Observational study. SETTING: Medicare administrative data. PARTICIPANTS: The study sample includes a total of 226,756 primary care clinicians and 54,597 practices that had at least 25 patients aged 65 or older, who were enrolled in Medicare fee-for-service or a Medicare Advantage plan between 2017 and 2019. MEASUREMENTS: The detection rate for mild cognitive impairment is assessed as the ratio between the observed diagnosis rate of a clinician or practice as documented in the data, and the expected rate based on a predictive model. RESULTS: The average detection rates for mild cognitive impairment is 0.08 (interquartile range=0.00-0.02) for both clinicians and practices, suggesting that only about 8% of expected cases were diagnosed on average. Only 0.1% of clinicians and practices had diagnosis rates within the expected range. CONCLUSIONS: Mild cognitive impairment is vastly underdiagnosed, pointing to an urgent need to improve early detection in primary care.
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Among over 200,000 clinicians and practices surveyed, only 0.1% had diagnosis rates within the expected range.
“Among over 200,000 clinicians and practices surveyed, only 0.1% had diagnosis rates within the expected range”
From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [271]
The Results (Tables 1–2) report 226,756 clinicians and 54,597 practices, with 0.1% of each having diagnosis rates no different from the expected rate. However, the Methods (Patient and Clinician Samples from Medicare Data) and Discussion describe an analysis of Medicare administrative data, not a survey of clinicians or practices. (LLM, conf=0.90)
Experimental — accuracy not yet measuredOnly 8% of older Americans living with MCI receive a diagnosis.
“One recent study estimates that only 8% of older Americans living with MCI receive a diagnosis.”
From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [271]
The low diagnosis rates are likely due to limited expertise and confidence and other factors.
“likely due to limited expertise and confidence and other factors discussed on the following pages”
From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [271]
There may be as many as 8 million people with undiagnosed MCI.
“suggesting there may be as many as 8 million people with undiagnosed MCI”
From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [271]
A recent study of Medicare beneficiaries found that only about 8% of expected mild cognitive impairment (MCI) cases are diagnosed on average.
“A recent study of Medicare beneficiaries found that only about 8% of expected mild cognitive impairment (MCI) cases are diagnosed on average, suggesting there may be as many as 8 million people with undiagnosed MCI”
From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [271]
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- Authors
- Liu, Y., Jun, H., Becker, A., Wallick, C., & Mattke, S.
- Affiliations
- University of Southern California (US)
- Harvard University (US)
- Genentech (US)
- Corresponding author
- Liu, Ying
- Venue
- The Journal of Prevention of Alzheimer's Disease
- Publisher
- Elsevier BV
- Published
- 2024-01
- Volume
- 11
- Issue
- 1
- Pages
- 7-12
- ISSN
- 2274-5807 (ISSN-L)
- PMC
- PMC10995024
- OpenAlex
- W4387960558
- Cited by
- 105
- References
- 28
- Citations by year
- 2026: 50 · 2025: 34 · 2024: 21
- FWCI
- 21.29
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- The Journal of Prevention of Alzheimer s Disease (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Genentech
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cancer-related cognitive impairment studies
- Health Sciences › Health Professions › Health Information Management › Medical Coding and Health Information
- Keywords
- mild cognitive impairment, underdiagnosis, primary care, Medicare, older adults, Alzheimer's disease, early detection, diagnostic rate, disease-modifying therapy, Medicare Advantage, fee-for-service
- MeSH terms
- Aged, Alzheimer Disease, Medicare, Humans, Primary Health Care, United States, Cognitive Dysfunction
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