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Study Examines ACA Impact On Cognitive Impairment

By Jill Sheridan

Posted April 13, 2018

An Indiana researcher co-authored the first study to look at whether or not an annual wellness visit improves the detection of cognitive impairment.

A 2011 mandate of the Affordable Care Act, ACA, added an annual wellness visit for people on Medicare that recommends detected cognitive impairments. But without guidance on how to do these tests, little progress was made in detecting diseases like Alzheimer's and dementia.

Nicole Fowler with the Indiana Center for Aging Research and the Regenstrief Institute co-authored the large-scale study that looked at Medicare recipients and cognitive impairment conditions like Alzheimer's since the ACA went into effect.

"There was clearly no differences in rates of diagnosis or medications," says Fowler.

The study suggests care providers did not have enough guidance and found there was also no increase in additional cognitive testing, including brain imaging.

There was an uptick in lab testing for thyroid and vitamin deficiency tests that may be linked to cognitive impairment.

Early detection and diagnosis can improve access to services and reduce health care costs. Fowler says much of her recent research focuses on the impact of early detection of Alzheimer's.

"The interest of early detection is because we really don't have a lot of evidence to know what are the benefits and risks of early detection," Fowler says.

Fowler says a policy that outlines how doctors may do cognitive screening could help improve implementation. It's estimated that between 40 and 70 percent of people who have cognitive impairment go undetected.

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