Advancement in the detection and treatment of Alzheimer’s and other neurodegenerative diseases means more people can preserve brain health for longer. But a crisis looms as an onslaught of people at risk for neurodegenerative diseases in the next 40 years is met with a shortage of health care providers. According to the U.S. Census Bureau, by 2060, there will be approximately 95 million people over the age of 65 and just 500,000 primary care providers.
A report published in the November/December 2024 issue of the Annals of Family Medicine outlines recommended guidelines from interdisciplinary geriatrics summits for an early cognitive impairment screening tool primary care providers can use in their practices. If impairment is detected, a multistep action plan was developed for further treatment.

The senior author of the report is Robin Hilsabeck, PhD, professor in the Department of Neurology, Joe R. and Teresa Lozano Long School of Medicine, division chief of the Clinical Neuropsychology Division and a faculty member with the Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases. She said cognitive impairment is often missed in early or mild cases, but when the condition is caught early, there is a better chance to preserve brain function and quality of life.
“There are so many things we’ve learned in the past 20 years — interventions that can slow cognitive loss, new treatments, and there is a pipeline for new drug development,” Hilsabeck said.
Beginning in 2017, a series of summits hosted by the National Academy of Neuropsychology gathered stakeholders from a variety of disciplines to figure out what could be done to meet the cognitive health needs of this expanding population. Hilsabeck, a past president of the academy, said she was especially interested in developing better tools for primary care providers.
“From the very beginning I’ve had primary care providers ask me, ‘Who do I send to you?’ and ‘How do I do this?’ and I’ve been working with them to try to address this problem,” she said.
Primary point of contact
As one of the most visited health care providers, primary care physicians often know their patients well and can play a crucial role in detecting cognitive issues. However, it is estimated that up to 60% of cognitive impairment cases are not diagnosed. Risk-based assessments may be the answer, as they target people who are most at risk of developing neurodegenerative diseases.
During the National Academy of Neuropsychology summit in November 2022, participants considered the pros and cons of current dementia screening and cognitive assessment tools. These tools evaluate risk factors like age, body mass index, history of heart conditions, education and antidepressant use, along with orientation and word recall items. The summit noted some tools have not been tested for use by primary care providers.
Quick, easy screening tool
Top considerations for a cognitive impairment screening tool that could be used by primary care providers included one that is:
- Easy to understand and deliver.
- Takes less than 10 minutes to complete.
- Is acceptable to the individual.
- Is sensitive to even mild stages of cognitive impairment.
- Includes assessment of both memory and executive function.
“Some of the earliest signs are changes in behavior and mood, and we need a better way to investigate these things early on,” Hilsabeck said.
A risk-predictor tool for primary care providers would likely be a combination tool that compiles health data from electronic medical records with in-office language processing and memory assessments. After the assessment is completed, Hilsabeck said primary care providers, the patient and their families decide what treatment the primary care provider can deliver and what treatment should be conducted with a dementia specialist.
“Some primary care providers are more comfortable [providing dementia care] than others, so there is a huge effort to provide more education so primary care providers feel more empowered, more confident to do some of these things, because they absolutely can,” she said.
Just the beginning
The 2022 findings and subsequent report are just the starting point, and research teams are investigating potential solutions. With early detection, health care providers, patients and their families can create a plan for moving forward and retaining a significant quality of life.
While an ideal time for cognitive screening is during an annual wellness visit, less than 34% of adults regularly complete annual wellness checks and only 30% of primary care providers screen for cognitive impairment during these visits. When a cognitive screen is done, less than 35% of patients follow up with a dementia specialist.
Hilsabeck said people can be resistant to accepting a cognitive impairment diagnosis for a variety of reasons including fear of losing freedom, stigma and strong emotions surrounding the condition.
“Facing [dementia diagnosis] might mean big changes, and it is scary. There is just so much emotion wrapped up in it,” she said.
What comes next?
While overall dementia prevalence is increasing, extensive efforts to educate health care providers and individuals are leading to earlier detection and treatment for these conditions. Hilsabeck said real progress in fighting these diseases will take a trifecta of support from health care providers, the health care system and patients and their families. suggested future efforts should focus on:
- Increased education about Alzheimer’s disease.
- Education about the benefits of early detection.
- A plan for clinical trials of multistep protocols for neurodegenerative disease screening and treatment plans.
With an ever-increasing older population and continued shortage of health care workers, Hilsabeck said it is critical that work begins now to uncover fast yet accurate tools to identify people at risk for Alzheimer’s and other neurodegenerative diseases.
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Small steps, big difference
Simple lifestyle changes like increasing exercise, boosting socialization and keeping blood pressure down can have big benefits for brain health.
‘Micro-dosing’ exercise
Short bursts of activity, such as 10 minutes of walking, a quick stretching session or other low-impact activities can have tremendous health benefits, Hilsabeck said. Exercise improves blood flow to the brain, which triggers beneficial neurotransmitters and can lead to better mood, memory and cognitive function.
Prescription for connection
Recent studies show that isolation and loneliness can have devastating effects on the brain. Connecting with friends and family, participating in a group activity, joining a club or taking a class can all lead to improved immune function and cardiovascular and cognitive health.
Magic number: 120
The Systolic Blood Pressure Intervention Trial (SPRINT) was a major national study that highlighted the positive effect of lowering blood pressure on many body systems, including the brain. Scientists found that lowering systolic blood pressure (the top number) to 120 or less was beneficial for the cardiovascular, renal and central nervous systems. Among the study’s more than 5,000 participants, those with a systolic reading of 120 or lower were significantly less likely to develop cognitive impairment over the next five years.