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Annual Visits May Not Increase Cognitive Impairment Detection

But Medicare wellness visits are tied to higher rate of testing for reversible causes of impairment

FRIDAY, April 20, 2018 (HealthDay News) — Medicare Annual Wellness Visits (AWVs) do not appear to substantially increase the detection of cognitive impairment in older adults, according to a study published online April 2 in the Journal of the American Geriatrics Society.

Nicole R. Fowler, Ph.D., from Indiana University in Indianapolis, and colleagues examined the effect of the Medicare AWVs on the detection of cognitive impairment and on follow-up cognitive care for older adults. The authors performed a retrospective matched-cohort study in a 5 percent random sample of fee-for-service Medicare beneficiaries enrolled continuously for 12 months before and after an index ambulatory visit from 2011 to 2013. Study participants had no claims evidence of cognitive impairment before the index visit.

The researchers found that there were no clinically relevant differences between the AWV group and matched controls in the rates of incident Alzheimer’s disease and related dementia (ADRD) diagnoses (6.16 versus 6.86 percent; P < 0.001) and initiation of ADRD medications (1 versus 1.08 percent; P = 0.15), although the AWV group had higher rates testing for thyroid-stimulating hormone (39.8 versus 28.36 percent; P < 0.001), B12 (9.41 versus 6.97 percent; P < 0.001), folate (4.76 versus 3.72 percent; P < 0.001), and neurobehavioral issues (0.75 versus 0.55 percent; P < 0.001).

“Although the AWV is correlated with an increase in some measures of cognitive care, such as laboratory testing for reversible causes of cognitive impairment, it does not appear to substantially increase recognition of undetected ADRD,” the authors write.

Several authors disclosed financial ties to Eli Lilly and Co., which funded the study.

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