Association Between Annual Wellness Visits and Early Dementia Diagnoses: Roles of Post-Visit Healthcare Decisions

Background and Objectives: Early recognition of cognitive impairment (CI) and timely diagnoses of mild CI (MCI) and Alzheimer's Disease and Related Dementias (ADRD) are key to optimal dementia care. No previous research has examined the extent to which healthcare interventions/services (specific blood tests, specialist referrals, and brain imaging) conducted after annual wellness visits (AWVs) contribute to subsequent MCI/ADRD diagnosis. We assessed the role of post-AWV healthcare services on the association of incident AWVs with the first ADRD or MCI diagnosis in Medicare enrollees. Methods: Propensity score matching of AWVs generated an active comparator cohort of Texas fee-for-service Medicare enrollees who received a Primary Care Provider visit, but without AWVs in 2018 (n = 66,443 in each group). Healthcare services (laboratory testing for CI: vitamin B12, thyroid stimulating hormone; specialist referrals: neurology, psychiatry; and brain images: CT, MRI) occurring after AWV and before the first MCI/ADRD diagnosis were examined. Results: Both groups had similar proportions of patients receiving specific blood tests, specialist referrals, and brain images in the 12 months before AWV/index date. Among those with no previous specialist visits, 39.2% in the AWV group and 31.1% in the non-AWV group received laboratory testing in the follow-up period. Similarly, among those with no previous brain images, 12.4% in the AWV group and 13.1% in the non-AWV group received brain images in the follow-up period. AWV receipt was associated with a 28% increase in MCI diagnosis; mediation analyses indicated that 14% of this increase was explained through post-AWV laboratory testing. AWV receipt was not associated with an increase in ADRD diagnosis. Discussion: Medicare AWV had a large direct effect on MCI diagnosis, but not on dementia diagnosis, suggesting that cognitive assessment and clinical evaluations during AWV directly contributed to the early recognition of MCI.