The Correlation Between Annual Wellness Visits, Diagnosis of Early Dementia
A cohort study aims to connect the dots between incident AWVs among older adults with the first ADRD or MCI diagnosis who receive Medicare fee-for-service benefits.
Proper dementia care involves the recognition of cognitive impairment at an early stage, while being able to diagnose Alzheimer disease and related dementias (ADRD) in a timely fashion. Having the ability to identify this cognitive impairment early on allows for clinicians to evaluate patients for treatable factors that are sometimes linked to cognitive impairment, such as sleep apnea, hypothyroidism, and poor hearing.
Keeping this in mind, one tactic that can help increase early cognitive impairment recognition rates is the implementation of annual wellness visits (AWVs).1 These normally feature personalized prevention plans, cognition and fall risk assessment, advance care planning consultation, and medication reconciliation. In 2011, the Centers for Medicare & Medicaid Services began reimbursing for AWVs with no cost to Medicare enrollees who were 65 years of age or older.
A retrospective population-based cohort study published in JAMA Network Open2 sought to determine the connection between incidents related to AMVs with a first diagnosis of mild cognitive impairment (MCI) or ADRD among adult patients who have Medicare fee-for-service benefits.
The study utilized Texas fee-for-service Medicare data from the 2015 to 2022 timeframe. It featured 549, 516 Medicare beneficiaries who were of age 68 or older in 2018; they also needed to have complete Medicare fee-for-service Parts A and B-and no Medicare Advantage plan enrollment from 2015 to 2018.
For those Medicare beneficiaries with no diagnosis of MCI or ADRD in 2015 to 2017 (mean [SD] age, 76.7 [6.6] years; 289,932 women [52.8%]), 66,433 (12.1%) had an incident AWV in 2018. Annual wellness visit recipients were more likely than those who did not receive an AWV to be female, to be non-Hispanic White (followed by Hispanic, non-Hispanic Black, and other), to have more education, to live in a metropolitan area, to have more comorbidities, and to have a primary care professional in the 12 months before the AWV index date.
Following propensity score matching, AWV receipt caused a 21% increase in MCI diagnosis (hazard ratio, 1.21 [95% confidence interval, CI, 1.16-1.27]) and a 4% increase in ADRD diagnosis (hazard ratio, 1.04 [95% CI, 1.02-1.06]). The increase in MCI diagnosis that was related to AWV was larger when the AWV was either treated as a time-dependent covariate in the follow-up period or censored.
According to the study authors, “This cohort study revealed that AWV recipients had a higher rate of first MCI diagnosis (21%) than those who did not receive an AWV, but little difference in first ADRD diagnosis (4%). Our study is the first showing the association of AWVs with early recognition of MCI in older adults. Annual wellness visits represent one strategy to address the family care burden of older adults with cognitive impairment by providing timely dementia care to maximize independent living for older adults with cognitive impairment. The Centers for Medicare & Medicaid Services should publicize the benefits of AWVs, including the potential to preserve independent living and aging in place of community-dwelling older adults through timely screening, dementia care, and treatment.”
References
1. Liss JL, Seleri Assunção S, Cummings J, et al. Practical recommendations for timely, accurate diagnosis of symptomatic Alzheimer’s disease (MCI and dementia) in primary care: a review and synthesis.J Intern Med. 2021;290(2):310-334. doi:10.1111/joim.13244
2. Tzeng H, Raji MA, Shan Y, Cram P, Kuo Y. Annual Wellness Visits and Early Dementia Diagnosis Among Medicare Beneficiaries. JAMA Netw Open. 2024;7(10):e2437247. doi:10.1001/jamanetworkopen.2024.37247
