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Review
. 2025 Jul;298(1):31-45.
doi: 10.1111/joim.20098. Epub 2025 May 23.

Implementing early detection of cognitive impairment in primary care to improve care for older adults

Nicole R Fowler  1   2   3 , Katherine A Partrick  4 , James Taylor  4 , Michael Hornbecker  5 , Kevin Kelleher  6 , Malaz Boustani  7 , Jeffrey L Cummings  8 , Tim MacLeod  5 , Michelle M Mielke  9 , Jared R Brosch  10   11 , Janice Lee  4 , Eli Shobin  12 , James E Galvin  13 , Howard Fillit  12 , Chinedu Udeh-Momoh  9   14 , Deanna R Willis  15
Affiliations
Review

Implementing early detection of cognitive impairment in primary care to improve care for older adults

Nicole R Fowler et al. J Intern Med. 2025 Jul.

Abstract

Primary care is the ideal setting for early detection of mild cognitive impairment (MCI) and Alzheimer's disease and related dementias (ADRD), as it serves as the primary point of care for most older adults. With the growing aging population, reliance on specialists for detection and diagnosis is unsustainable, highlighting the need for primary care-led assessment. Recent research findings on successful brain health prevention strategies, AD diagnostic tools, and anti-amyloid treatments empower primary care to play a central role in early detection and intervention. Primary care-focused resources are being developed, including tools for cognitive assessments and materials designed to educate patients about brain health and initiate discussions on lifestyle modifications, thereby making early detection more feasible and efficient. Identifying risk factors early enables providers to implement interventions that can slow cognitive decline and improve outcomes for patients and caregivers. If left undetected and unmanaged, MCI and ADRD can lead to worse outcomes, including increased falls, hospitalizations, financial vulnerability, and caregiver stress. Early detection enables the identification of reversible causes of cognitive impairment, supports the management of comorbidities worsened by cognitive decline, mitigates safety risks, and can preserve quality of life. Importantly, primary care is essential for addressing ADRD-related health disparities that disproportionately affect racial minorities, rural populations, and those of lower socioeconomic status. With a focus on the United States healthcare system, this perspective addresses how implementing early detection practices into primary care can improve outcomes for patients and caregivers, reduce societal burdens, and promote health equity in ADRD care.

Keywords: Alzheimer's disease; cognitive assessment; cognitive impairment; dementia; early detection; primary care.

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Conflict of interest statement

N.R.F. has grants from the National Institutes of Health. K.A.P. and J.L. received compensation from Voices of Alzheimer's for editorial services related to this manuscript. J.T. is the founder and CEO of Voices of Alzheimer's. J.L.C. has provided consultation to Acadia, Acumen, ALZpath, Annovis, Aprinoia, Artery, Biogen, Biohaven, BioXcel, Bristol‐Myers Squib, Eisai, Fosun, GAP Foundation, Green Valley, Janssen, Karuna, Kinoxis, Lighthouse, Lilly, Lundbeck, LSP/eqt, Merck, MoCA Cognition, New Amsterdam, Novo Nordisk, Optoceutics, Otsuka, Oxford Brain Diagnostics, Praxis, Prothena, ReMYND, Roche, Scottish Brain Sciences, Signant Health, Simcere, sinaptica, TrueBinding, and Vaxxinity pharmaceutical, assessment, and investment companies. J.L.C. is supported by NIGMS grant P20GM109025; NIA R35AG71476; NIA R25AG083721‐01; NINDS RO1NS139383; Alzheimer's Disease Drug Discovery Foundation (ADDF); Ted and Maria Quirk Endowment; Joy Chambers‐Grundy Endowment. M.B. serves as a Chief Scientific Officer and Co‐Founder of BlueAgilis; the Chief Health Officer of DigiCare Realized, Inc.; and the Chief Health Officer of Mozyne health, Inc. M.B. has equity interest in Blue Agilis, Inc.; DigiCare Realized, Inc.; and Mozyne Health, Inc. M.B. sold his equity in Preferred Population Health Management LLC; and MyShift, Inc. (previously known as RestUp, LLC). M.B. serves as an advisory board member or consultant for Eli Lilly and Co.; Eisai, Inc.; Merck & Co Inc.; Biogen Inc.; and Genentech Inc. M.M.M. has served on scientific advisory boards and/or has consulted for Althira, Biogen, Eisai, LabCorp, Lilly, Merck, Roche, and Siemens Healthineers received speaking honorariums from Novo Nordisk, PeerView Institute, and Roche and receives grant support from the National Institute of Health, Department of Defense, Alzheimer's Association, and Davos Alzheimer's Collaborative. J.E.G. has grants from the National Institutes of Health, serves as Chief Scientific Officer for Cognivue, Inc., and serves as a consultant for Biogen, BMS, CervoMed, Cognivue, Cognition Therapeutics, Eisai, Eli Lilly, GE Healthcare, Lundbeck, and Roche. M.H. receives consulting fees from the Davos Alzheimer's Collaborative and Neurotrack Technologies and has served on advisory boards for Eisai, Novo Nordisk, and Eli Lilly. M.H. is a shareholder of Eli Lilly. T.M. receives consulting fees from the Davos Alzheimer's Collaborative. H.F. has consulted with Alector, LifeWorx, Mediflix, Samus Therapeutics, Otsuka Pharmaceuticals, and Pinteon Therapeutics and has served as an unpaid consultant for Eli Lilly. E.S. is a shareholder of Eli Lilly, Biogen, and AbbVie. K.K. and D.R.W. declare no conflicts of interest. J.R.B. serves on advisory boards for Eli Lilly, Eisai, and AbbVie and receives research support from Alzheimer's Association Part of the Cloud award, AbbVie, Alnylam Pharmaceuticals, Athira, Biogen, Eisai America Inc, Eli Lilly and Company, F. Hoffman‐La Roche Ltd., Washington University, Takeda Pharmaceuticals, and University of Southern California. C.U. is a paid consultant at Aga Khan University and receives research grant support from the National Institute of Health, Alzheimer's Association, UK Medical Research Council, UK Defence and Security Accelerator, Davos Alzheimer's Collaborative, and Wellcome Leap and Temasek Trust.

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