Feasibility and Acceptability of Implementing a Digital Cognitive Assessment for Alzheimer Disease and Related Dementias in Primary Care

Topic: Risk, prevention and care in population studies

There were 16,708 eligible encounters during the 12-month study period (June 2022-May 2023). A total of 1,808 DCAs (10.8%) were completed by 1,722 unique patients; 3,727 (22.3%) declined, and at 9,232 encounters (55.3%) the physicians declined to have the patient complete the DCA or the encounter was deemed out of scope. Among those who completed DCAs, results for 762 (44.3%) were categorized as unimpaired, 628 (36.5%) borderline, 236 (13.7%) impaired, and 96 (5.6%) inconclusive. Among the 236 patients who were categorized as impaired, 2.1% received a new diagnosis of ADRD, and 5.1% received a new diagnosis of mild cognitive impairment within 90 days after the DCA. One-half of all patients scored impaired or borderline for cognitive impairment. Digital cognitive assessments can be implemented in primary care, have utility for early detection, and could represent the first step in identification of patients who could benefit from ADRD disease-modifying therapeutics, care management, or other interventions to improve patient and family caregiver outcomes.

Key findings

• There were 16,708 eligible encounters during the 12-month study period (June 2022-May 2023).
• A total of 1,808 DCAs (10.8%) were completed by 1,722 unique patients; 3,727 (22.3%) declined, and at 9,232 encounters (55.3%) the physicians declined to have the patient complete the DCA or the encounter was deemed out of scope.
• Among those who completed DCAs, results for 762 (44.3%) were categorized as unimpaired, 628 (36.5%) borderline, 236 (13.7%) impaired, and 96 (5.6%) inconclusive.
• Among the 236 patients who were categorized as impaired, 2.1% received a new diagnosis of ADRD, and 5.1% received a new diagnosis of mild cognitive impairment within 90 days after the DCA.
• One-half of all patients scored impaired or borderline for cognitive impairment.

Why it matters

This study found that a digital cognitive assessment could be implemented in primary care, with 10.8% of eligible visits completing it and about half of those tested scoring impaired or borderline. Among patients categorised as impaired, 2.1% received a new diagnosis of Alzheimer's disease and related dementias and 5.1% a new diagnosis of mild cognitive impairment within 90 days.

New to this subject? Start with our plain-English guide: Getting a diagnosis →

Study details

• Participants236
• Effect size10.8%; 22.3%; 55.3%
• Evidence strengthLow

Read the original

• DOI: 10.1370/afm.240293
• PubMed: 40300815
• Original source →
• Free full text: The Annals of Family Medicine →

Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).

@article{fowler2025-40300815,
  author  = {Fowler, Nicole R. and Hammers, Dustin B. and Perkins, Anthony J. and Summanwar, Diana and Higbie, Anna and Swartzell, Kristen and Brosch, Jared R. and Willis, Deanna R.},
  title   = {{Feasibility and Acceptability of Implementing a Digital Cognitive Assessment for Alzheimer Disease and Related Dementias in Primary Care}},
  journal = {The Annals of Family Medicine},
  year    = {2025},
  doi     = {10.1370/afm.240293},
  pmid    = {40300815},
  url     = {https://doi.org/10.1370/afm.240293}
}

Later studies that cite this one

3 studies in the alzhub library list this one in their references.

• Benefits and Harms of Dementia Screening for Family Members of Older Adults: A Randomized Clinical Trial JAMA Internal Medicine · 2026-06-01 · usefulness score 60/100 · Getting a diagnosis
• Streamlining eligibility assessment for Alzheimer's disease-modifying therapies: Prediction of MMSE scores using the digital clock and recall Frontiers in Digital Health · 2026-07-09 · usefulness score 43/100 · Cognitive tests and assessment
• Feasibility of remote self-administered cognitive assessment in an Alzheimer's disease treatment clinic medRxiv (preprint) · 2026-09-16 · usefulness score 16/100 · Treatments

Related studies in Getting a diagnosis

• Agile Implementation of a Digital Cognitive Assessment for Dementia in Primary Care The Annals of Family Medicine · 2025-04-29 · usefulness score 45/100
• Digital Detection of Dementia in Primary Care: A Randomized Clinical Trial JAMA Network Open · 2025-11-03 · usefulness score 70/100
• Alzheimer's Association clinical practice guideline for the Diagnostic Evaluation, Testing, Counseling, and Disclosure of Suspected Alzheimer's Disease and Related Disorders (DETeCD-ADRD): Executive summary of recommendations for primary care Alzheimer's & Dementia · 2024-12-23 · usefulness score 70/100
• Provider, Interdisciplinary Staff, and Patient Perspectives on the Potential for Cognitive Assessment and Care Plan Services in Primary Care Journal of Primary Care & Community Health · 2025-07-01 · usefulness score 36/100
• Total and Structural Carotid Artery Stiffness Are Associated With Cognitive Decline and Structural Brain Abnormalities Related to Alzheimer Disease and Alzheimer Disease‐Related Dementias Pathology: The Multi‐Ethnic Study of Atherosclerosis Journal of the American Heart Association · 2025-05-02 · usefulness score 59/100
• Documentation and evaluation of cognitive impairment in elderly primary care patients Annals of internal medicine · 1995-03-01 · usefulness score 67/100

Similar studies

• Focus groups on digital cognitive assessment in the context of Alzheimer's disease 2025 · Getting a diagnosis
• Acceptable standards for clinic‐based digital cognitive assessments: Recommendations from the Global CEO Initiative on Alzheimer's Disease 2025 · Getting a diagnosis
• Review of Artificial Intelligence for Clinical Use in Alzheimer's Disease and Related Dementias 2025 · Getting a diagnosis
• Review of brief cognitive tests for patients with suspected dementia 2014 · Cognitive tests and assessment
• Current understanding of Alzheimer's disease diagnosis and treatment 2018 · Getting a diagnosis
• Feasibility of telecognitive assessment in dementia 2006 · Disparities

More on Getting a diagnosis

• A review that covers this ground Mini-Mental State Examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations The Cochrane database of systematic reviews · 2016-01-13 · usefulness score 76/100
• Newest in this subject The Contribution of Routinely Collected Clinical Data to Dementia Identification in Primary Care: A Cross-Sectional Study Research Square · 2026-10-28 · Preprint — not yet peer-reviewed · usefulness score 16/100
• Newest in this subject Beyond “Denial”: Understanding and Responding to Help-Refusal in Dementia Preprints.org · 2026-10-26 · Preprint — not yet peer-reviewed · usefulness score 16/100

See all studies in Getting a diagnosis →