title: Alzheimer's Association recommendations for operationalizing the detection of cognitive impairment during the Medicare Annual Wellness Visit in a primary care setting.
abstract: The Patient Protection and Affordable Care Act added a new Medicare benefit, the Annual Wellness Visit (AWV), effective January 1, 2011. The AWV requires an assessment to detect cognitive impairment. The Centers for Medicare and Medicaid Services (CMS) elected not to recommend a specific assessment tool because there is no single, universally accepted screen that satisfies all needs in the detection of cognitive impairment. To provide primary care physicians with guidance on cognitive assessment during the AWV, and when referral or further testing is needed, the Alzheimer's Association convened a group of experts to develop recommendations. The resulting Alzheimer's Association Medicare Annual Wellness Visit Algorithm for Assessment of Cognition includes review of patient Health Risk Assessment (HRA) information, patient observation, unstructured queries during the AWV, and use of structured cognitive assessment tools for both patients and informants. Widespread implementation of this algorithm could be the first step in reducing the prevalence of missed or delayed dementia diagnosis, thus allowing for better healthcare management and more favorable outcomes for affected patients and their families and caregivers.
authors.affiliation: Alzheimer's Association, Chicago, IL, USA. cyndy.cordell@alz.org
authors.forename: Cyndy B
authors.initials: CB
authors.lastname: Cordell
authors.forename: Soo
authors.initials: S
authors.lastname: Borson
authors.forename: Malaz
authors.initials: M
authors.lastname: Boustani
authors.forename: Joshua
authors.initials: J
authors.lastname: Chodosh
authors.forename: David
authors.initials: D
authors.lastname: Reuben
authors.forename: Joe
authors.initials: J
authors.lastname: Verghese
authors.forename: William
authors.initials: W
authors.lastname: Thies
authors.forename: Leslie B
authors.initials: LB
authors.lastname: Fried
mesh_terms: D000465:Algorithms; D000544:Alzheimer Disease / Q000175:diagnosis*; D003072:Cognition Disorders / Q000175:diagnosis*; D042241:Early Diagnosis; D006801:Humans; D006278:Medicare; D058991:Patient Protection and Affordable Care Act; D011320:Primary Health Care / Q000379:methods* / Q000592:standards; D018570:Risk Assessment / Q000379:methods* / Q000592:standards; D014481:United States