Home › Research › Health systems and care delivery
Dementia diagnostic deserts: workforce and geographic inequities in the diagnostic pathway for cognitive impairment
Xu Zhijing, Xue Ying, Zheng Yaguang, Wu Bei. Health affairs scholar, 2026-05-29
Topic: Risk, prevention and care in population studies
As disease-modifying therapies for Alzheimer's disease become available, ensuring equitable access to timely and accurate diagnosis of cognitive impairment is critical. This article conceptualizes "dementia diagnostic deserts," defined as geographic areas where rurality, primary care professional shortages, and high social deprivation converge to exacerbate access to the diagnostic continuum, from initial screening and comprehensive evaluation to the appropriate referral for specialist-based diagnostic confirmation. Using a multidimensional framework, we identify "Triple Disadvantage Zones" where these barriers intersect most severely, leading to diagnostic errors, characterized by failure to differentiate subjective complaints from objective impairment. This diagnostic failure produces 2 distinct forms of diagnostic inequity: delayed diagnosis for those with true pathology, and inappropriate over-testing for those who do not meet clinical criteria. Nurse practitioners and physician assistants are frontline providers in these underserved regions but face significant training gaps and practice-level infrastructure barriers. Addressing these disparities requires a multidimensional policy approach that targets the convergence of geographic, workforce, and socioeconomic barriers rather than rurality alone. We propose a coordinated policy agenda focused on comprehensive clinical triage training, appropriate reimbursement for clinician time, financial assistance for diagnostic testing, and investments in practice-level capacity for the entire diagnostic pathway and subsequent care.
Key findings
- Nurse practitioners and physician assistants are frontline providers in these underserved regions but face significant training gaps and practice-level infrastructure barriers.
Why it matters
This article describes 'dementia diagnostic deserts' and 'Triple Disadvantage Zones' where rurality, primary care shortages and social deprivation combine to worsen access to diagnosis, and notes training gaps among nurse practitioners and physician assistants. It is about diagnostic inequity and does not report any treatment, cure or prevention.
Study details
- Evidence strengthLow
How this study scored 43/100
Published in a peer-reviewed journal. Scored zero for study design, sample size, effect reported, studied in people and randomised / blinded because the record does not state it. We have no data on times cited, citations per year, impact for its field and year, cited by studies here, still being cited and senior author's track record, so those were left out: it earned 29 of the 68 points we could judge it on, which is 43 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Health affairs scholar) |
| Journal's citation record | 0 / 4 | Health Affairs Scholar: journal h-index 21 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 5 / 5 | 2026 — within 1 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | — / 7 | Citation count not trusted: 31 of 83 library studies citing it were published more than a year before it - a sign OpenAlex merged several works under this DOI — left out of this score |
| Citations per year | — / 5 | Citation count not trusted (see above) — left out of this score |
| Impact for its field and year | — / 6 | Citation count not trusted (see above) — left out of this score |
| Cited by studies here | — / 6 | Library citations not trusted (see above) — left out of this score |
| Still being cited | — / 4 | Citation count not trusted (see above) — left out of this score |
| Senior author's track record | — / 4 | OpenAlex's profile for last-listed author Bei Wu holds only 4 work(s), too few to judge a track record — left out of this score |
| Institution's track record | 2 / 3 | New York University: institution h-index 1,612 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 4 institution(s) in 2 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 42211564) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 29 / 68 | Scored on 14 of 20 parts. We have no data for the rest, so they are left out: 29 of the 68 points we could judge it on is 43 out of 100. |
| Total | 43 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
Free copy unknown: no free-copy check has an answer for this record yet. That does not mean it is paywalled.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Zhijing, X., Ying, X., Yaguang, Z., & Bei, W. (2026). Dementia diagnostic deserts: workforce and geographic inequities in the diagnostic pathway for cognitive impairment. Health affairs scholar. https://doi.org/10.1093/haschl/qxag109
Vancouver
Zhijing X, Ying X, Yaguang Z, Bei W. Dementia diagnostic deserts: workforce and geographic inequities in the diagnostic pathway for cognitive impairment. Health affairs scholar. 2026. doi:10.1093/haschl/qxag109. PMID: 42211564.
BibTeX
@article{zhijing2026-42211564,
author = {Zhijing, Xu and Ying, Xue and Yaguang, Zheng and Bei, Wu},
title = {{Dementia diagnostic deserts: workforce and geographic inequities in the diagnostic pathway for cognitive impairment}},
journal = {Health affairs scholar},
year = {2026},
doi = {10.1093/haschl/qxag109},
pmid = {42211564},
url = {https://doi.org/10.1093/haschl/qxag109}
}
Studies this one cites
Referenced by this study and also in the alzhub library, so you can read them here. Showing 12 of 49.
Later studies that cite this one
83 studies in the alzhub library list this one in their references. Showing the 8 highest-scoring.
Related studies in Health systems and care delivery
Also tagged “prevalence”
1,224 studies in the library carry the topic tag “prevalence”; these are this study's neighbours in a fixed, alphabetical-by-hash tour of them, not the closest in content. All 1,224 tagged studies.