Objective:

To identify gaps in primary care in identifying, evaluating, and referring patients with MCI to neurology in a large integrated health system.

Background:

Early diagnosis of MCI is paramount in this new era of disease-modifying therapies for Alzheimer’s dementia. Primary care physicians (PCPs) are the first point of contact for patients with memory loss, however rates of diagnosis, and referral to Neurology for MCI remain understudied. 

Design/Methods:

We conducted a retrospective study using electronic health records, to identify patients aged ≥65 years evaluated by PCP between 2021-2024 with incident (first time) diagnosis of memory loss (R41.3) or MCI (G31.84. We excluded patients with an established diagnosis of dementia, vascular and Parkinsons dementia. We assessed the frequency of cognitive tests, screening labs (B12, TSH), brain imaging (CT, MRI), and referrals to neurology. We also assessed any disparities in gender and race/ethnicities.

Results:

Among 294,731 primary care patients aged ≥65 years, 19,656 (6.7%) had incident diagnosis of memory loss and 7,039 (2.3%)  had MCI. The incidence was higher for females at 7.1 % (vs 6.1 % in males) and blacks at 7.4% compared to other ethnicities.

19.1% received MMSE and 0.7% MOCA by PCP. TSH was ordered in 73.4%, B12 in 50%, with rates slightly lower for Blacks (54 and 45.2% respectively). Brain imaging was ordered in 35%. 31.6% received a referral to neurology, with slightly higher rates for Asians (41.1%) and Blacks (38.5%) with p value = 0.001. 

Conclusions:

These data show lower diagnostic incidence rates of MCI relative to the expected actual incidence of 10-20% ≥65 years.

Further studies to understand barriers to detect MCI in primary care are needed. Solutions such as outreach/education, standardized screening and care pathways, and improved access to neurologists are critical to ensure timely evaluation of MCI in order to optimize disease modification and delay progression to dementia.