In my primary care practice, few moments carry as much quiet weight as when an older patient leans in and says, “Doctor, I’m worried about my memory.” That moment is increasingly common, given that an estimated 42 percent of adults who reach age 55 will develop dementia in their lifetime, so nearly every family will face a version of it. It takes courage to say those words out loud, but our health care system too often dismisses memory issues as a normal part of aging, when it doesn’t have to be.
A study published in Alzheimer’s & Dementia perfectly encapsulates this widespread challenge. Only 5.4 percent of patients who reported a new memory concern at their Medicare Annual Wellness Visit (AWV) received a cognitive assessment, and just 2.1 percent were referred to a specialist. The AWV already requires clinicians to look for cognitive problems, so these were patients who named the exact issue we are meant to catch. Of the 1,411 patients studied, more than 9 in 10 still walked out without an assessment or referral.
It’s critically important that we as PCPs leverage every tool in our toolbox to address this missed opportunity. A short, AI-based cognitive assessment can find these patients early, right inside the primary care visit, and with early interventions and personalized brain health action plans, we can help change the trajectory of these patients’ lives.
Missed opportunities
PCPs are working in good faith, even under enormous pressures. We are stretched thin, with only minutes per visit and no clear pathway to turn a patient’s memory concern into a cognitive assessment and a plan. That is perhaps one of the reasons why primary care identifies only about 8 percent of the mild cognitive impairment it should be detecting, which leaves more than 7 million Americans living with an early, often treatable condition they know nothing about.
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When a memory concern goes unaddressed, delay compounds the harm. A dementia diagnosis arrives on average 3.5 years after symptoms first appear, and the wait stretches longer for younger patients and for people of color. Every month of delay narrows the window when a clinician can still intervene, when lifestyle change carries the most weight, and when families can plan while their loved one still has a strong voice in those decisions.
Waiting also squanders the chance to fix problems outright, because some cognitive impairment traces to reversible causes such as sleep disorders, medication side effects, vitamin deficiencies, depression, or thyroid disease. The economic stakes track the human ones, as dementia now costs the country an estimated $781 billion a year, much of it driven by late-stage care that earlier detection could help reduce.
Lessons from oncology
Two generations ago, medicine faced the same kind of gap in breast cancer, but closed it. Historically, physicians typically waited until a lump appeared, then treated a cancer that had often already spread. Routine mammography rewrote that story, and early large-scale trials reported a roughly 31 percent reduction in mortality among women invited for screening. Finding disease earlier, at scale, changed the outcome.
In dementia, the same opportunity is within reach. Up to 45 percent of cases could be prevented or delayed by addressing modifiable risk factors, the 2024 Lancet Commission estimates. Earlier detection can expand clinicians’ access to proven interventions and offer more time to use them.
Similarly, just as Medicare coverage once made mammography routine, the bipartisan Alzheimer’s Screening and Prevention (ASAP) Act would open a pathway for Medicare to cover tests that detect Alzheimer’s earlier. The Alzheimer’s Association has framed this embrace of early detection as brain health’s mammogram moment. The label fits, given that the tests exist, but insurance coverage is what truly turns them into the standard of care.
Making assessment routine
The clinical tools available appear well-suited for this moment. A short digital assessment captures hundreds of data points beyond the reach of a paper test, from the timing of a pen stroke to subtle patterns in speech, and AI analyzes them in minutes rather than the two to three hours a full neuropsychological evaluation demands. That analysis gives a primary care team specialist-level insight at the point of care, turning a memory concern into clear clinical indicators and a plan to act on, the same day rather than a months-long wait.
Making cognitive assessments part of everyday practice will require deliberate choices by health system leaders. Four steps would move us quickly:
- Treat a reported memory concern as an actionable finding, with a documented response at the same visit.
- Build a brief cognitive assessment into the AWV, where federal rules already require attention to cognition.
- Equip primary care with validated assessments, so detection does not hinge on a scarce specialist.
- Decide in advance what a positive result triggers: a fuller evaluation, a care plan, or a targeted specialist referral.
Even without a single new discovery, we could close this detection gap today. The assessments are validated and take only minutes, and patients are already speaking up. When an older person summons the courage to voice their concern, our job is to meet them with more than a reassuring nod. We owe them a clear answer and a plan, while there is still time to change the outcome.
Health systems that build readiness now will spare countless families years of avoidable uncertainty and set the standard for brain health for the next generation.
This essay is cited in the KevinMD record on primary care.
John Showalter is board-certified in internal medicine and informatics and serves as chief operating officer of Linus Health, an AI-driven brain health company focused on early detection and proactive intervention. Linus Health has won Time Magazine’s Best Inventions and Fast Company’s Innovation by Design awards for its work bringing the power of digital cognitive assessments to PCPs.
He practices medicine in Danville, Pa., with a focus on cognitive care and dementia prevention. He can be found on LinkedIn.
