F04 – Can you Refresh my Memory? Addressing Mild Cognitive Impairment in Primary Care Across the Lifespan

Summary

Mild Cognitive Impairment (MCI) is an issue that arises in primary care often and presents an increased risk of cognitive decline. Approximately 13% or 43.3 million of primary care patients over the age of 60 years experience MCI at any given time and only 16%-33% discuss this issue with a primary care provider (PCP), and less than half of PCPs have a standard protocol to address MCI. Not only does this impact the older adult population, but MCI is also seen across the lifespan. It is connected to many etiologies including neurodegenerative disease (e.g., Alzheimer’s), chronic health conditions (e.g., Diabetes and other endocrine disorders, Cardiovascular Disease, Chronic Kidney Disease) and can be an iatrogenic effect from medical treatments (e.g., post-anesthesia impairment) and medications commonly prescribed in the primary care setting (e.g., antiseizure medications, statins, corticosteroids). Further, many conditions (e.g., anxiety, depression, sleep apnea) can contribute to day-to-day cognition which once treated, can resolve, or improve cognitive complaints, making determination of underlying objective cognitive impairment more feasible. Behavioral health and primary care providers have varying levels of training in cognitive screening practices and because of this, MCI-related issues often go untreated which can impact treatment adherence to complicated treatment regimens, impact psychological treatments offered by behavioral health providers, and delay referrals for more precise diagnostic clarification and treatment. Additionally, primary care practices in rural and underserved areas may not have access to refer to clinical neuropsychologists. Thus, it is important to equip behavioral health providers practicing within primary care settings with evidence-based screening practices and tools to address cognitive impairment in primary care. This presentation will provide an overview of the impact of MCI in primary care across the lifespan, the importance of addressing MCI early in order to help the slow progression to dementia, review evidenced-based cognitive screening tools appropriate for the primary care settings and provide example algorithms for addressing cognitive impairment for the primary care setting. This topic is of importance due the impact of primary care offering patients and their families secondary and tertiary prevention options to address MCI which can have immense personal, familial, and broader societal benefits.