Physician Survey Results: Primary Care Knowledge of Screening for Cognitive Decline
New survey finds that most PCPs screen for mild cognitive impairment, but time is an issue, guidelines are few, and low levels of confidence persist.
Clinician specialty: The majority of survey respondents (72%) practice primary care, with 36% each identifying as in family medicine and internal medicine practices.
Use of brief cognitive assessments: Nearly two-thirds of respondents said they do conduct these short evaluations for mild cognitive impairment in their daily clinical practice while the remaining one-third do not.
Barriers to performing cognitive assessments: Lack of time during a clinical visit, eg, an annual wellness visit, was the most common reason given for not conducting the assessment. Nearly 1 in 5 respondents chose lack of guidelines for primary care practitioners as the reason, followed closely by lack of confidence in providing follow-up and in interpreting assessment results.
Cognitive assessment tools used: Close to half (44%) who do perform cognitive testing use the Mini-Cognitive Assessment Instrument and more than one-third said the use the Folstein Mini-Mental Status Examination. Approximately 1 in 10 employ the Montreal Cognitive Assessment, or MoCA, and very few utilize the Brief Cognitive Assessment Tool.
Family members report symptoms: More than two-thirds (68%) of clinicians agreed that family members are frequently the first to voice concern about a spouse or relative's waning cognitive health with less than a quarter (23%) noting that it's not often the case and an even smaller proportion (8%) saying it it's always someone other than the patient.
Comfort with starting the conversation: Three-quarters of this group of primary care clinicians said they are "very comfortable" (50%) or "somewhat comfortable" (27%) initiating dialogue with a patient when there is suspicion for cognitive impairment, with the proportion of respondents with the greater confidence greater by 2 than those with less. About 1 in 5 (18%) claimed "moderate comfort" and only a small fraction of the group (4%) said they were not at all comfortable.
Confidence in differentiating symptoms: Approximately 1 in 5 respondents said they felt "very confident" (21%) or "moderately confident" (22%) in discriminating between signs and symptoms characteristic of the aging process and those suggesting early cognitive decline, while close to one-half (47%) expressed some confidence.
Knowledge of neurocognitive health: About two-thirds (64%) of the survey respondents feel their knowledge of neurocognitive health is either very good (24%) or adequate (40%) while the other one-third feel they could learn more.
Observed incidence of cognitive impairment in practice: The rate of cognitive impairment among patients seen recently appears to be increasing for 46% of clinician respondents, although this could be an artifact of aging in the practice census. Approximately one-third are not sure if the proportion has gone up and just under one-quarter agreed they have not seen an increase.
Familiarity with oral medications approved for symptomatic Alzheimer dementia (AD): More than one-quarter (27%) indicated they are "very familiar" with the drugs the FDA has approved to treat symptoms of AD and close to half are "somewhat familiar." Just ~10% answered they are not at all familiar.
Medications prescribed for early cognitive decline: Donepezil (Aricept) and galantamine (Razadyne) have been prescribed by 75% and 49% of respondents, respectively, while about one-third (37%) and one-quarter (25%) have experience with rivastigmine and memantine, respectively.
Length of wait for specialist referral: Half of respondents said that the delay between request for a specialty consult and an available appointment is from 1 to 3 months; for more than one-quarter (28%) the wait can be 6 months or longer. For just less than 1 in 5 respondents, the interval is relatively short, about 2-3 weeks.
As the number of aging adults expands and rates of cognitive decline rise, primary care clinicians will remain the first point of contact for detection and early management—so how prepared do they feel for this role? A new survey of US primary care clinicians conducted by Patient Care© offers a snapshot of current attitudes, practices, and knowledge related to cognitive assessment in the clinical setting and familiarity with standard-of-care medications.
While a majority report conducting annual screenings for mild cognitive impairment, barriers such as limited time, uncertainty about guidelines, and a lack of confidence in interpreting results persist. The survey also highlights variation in tool selection and notable gaps in clinicians’ self-reported familiarity with distinguishing early cognitive decline from normal aging. These findings shed light on the opportunities—and ongoing challenges—of integrating cognitive health for older adults into routine primary care.
The slides above provide visual highlights of the results. For open-ended responses regarding challenges to conducting cognitive screening voiced by survey respondents, see 5 Challenges Physicians Face With Cognitive Screening in Practice.
