CRITICAL ROLE OF PRIMARY CARE PHYSICIANS (PCPs)
Detecting AD early is critical1-3
Could you be seeing patients in your practice who already have Alzheimer’s disease (AD)?
~1 in 3 patients with AD have risk factors, such as diabetes, depression, and cardiovascular disease. These and other conditions can put patients at greater risk for AD.4-6
These factors could help you identify patients who may be at risk for AD.
THE ROLE OF RISK FACTORS
A shared pathway may also connect some of these conditions to AD.6
Actor portrayals.
Data show it can take 1-4 years to diagnose AD, which may be due to3,7-10:
- Delays in patient presentation, challenges in making a diagnosis of AD, and limited treatment options3,7-10
- Stigma, fear, and denial, which may contribute to health care avoidance—keeping patients from talking to their doctors and family members, even when symptoms of cognitive impairment become noticeable3,7,11
Start with proactive cognitive assessment2
Only
of seniors RECEIVE REGULAR ASSESSMENTS*
Only 16% of seniors* report receiving regular cognitive assessments during routine health checkups—a much lower number than regular screening or preventive services for other conditions like diabetes or high cholesterol.12†
* |
Aged ≥65 years. |
† |
Alzheimer’s Association Facts & Figures 2019. |
|
PCP, primary care physician. |
EARLY SIGNS CAN BE MILD COGNITIVE IMPAIRMENT (MCI)
MCI is not normal aging and can be an early stage of Alzheimer’s disease7,13
See AD differently
Evolving science is revealing that multiple mechanisms may drive the development of AD.4,15-17
Patients may also present with symptoms of MCI for other reasons, including14:
- Medication side effects
- Sleep apnea or deprivation
- Psychiatric disorders such as anxiety or depression
- Vascular disease or traumatic injury
- Other forms of dementia (Parkinson’s disease or dementia with Lewy bodies)
Actor portrayals.
A differential diagnosis is important to assess for potentially reversible causes of MCI (eg, metabolic, vascular, or psychiatric disorders) and rule out other forms of dementia.18
KEY TAKEAWAY
It’s important to identify patients with symptoms of MCI early through cognitive assessment because the underlying cause can be early AD.2,3,13
Actor portrayal.
Risk factors for MCI include14,19:
- Increasing age
- Medical conditions or factors such as:
- Hypertension
- Obesity
- Hypercholesterolemia
- Sedentary lifestyle
- Depression
- Smoking
- Diabetes
- Infrequent participation in mentally or socially stimulating activities
- Hearing loss
- Sleep disturbance
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PROACTIVELY ASSESSING PATIENTS
A yearly assessment of cognitive function is a required component of the US Medicare system’s annual wellness visit for all people aged ≥65 years.14,20
IMPORTANCE OF PROACTIVE ASSESSMENT
Proactive cognitive assessment is critical to early diagnosis and intervention1-3
The first pathological changes in the brains of patients with AD begin decades before clinical symptoms appear, underscoring the critical need for early detection of cognitive impairment.1,13,16,21
AD IS A MULTIFACTORIAL DISEASE
It’s time to look beyond plaques and tangles to discover what else could be driving these changes.
Patients want their diagnosis as soon as possible
~4 in 5 US adults say they would want to know if they had AD before experiencing symptoms or before symptoms interfere with daily activities.13*
* |
Based on a survey of US adults aged 45 and older. |
An earlier diagnosis of AD can allow patients and families access to treatment options and management resources at an earlier stage of disease, helping them to plan for the future. These measures can improve patient outcomes and could result in substantial cost savings to health care systems.1,3,22
FIRST STEP TO EARLY DIAGNOSIS
A validated cognitive assessment is the first step to early diagnosis1-3,23
The sooner Alzheimer’s disease (AD) can be diagnosed, the sooner management steps can be put in place. Patients get the best chance for early diagnosis and intervention to help slow progression when PCPs proactively evaluate cognitive function.1-3,23
PCPs are responsible for an initial cognitive workup, which includes12,13,24:
- Reviewing medical history and medications
- Performing a physical exam
- Ordering blood tests to evaluate potential causes of cognitive impairment
- Conducting a cognitive test
- Ordering imaging as needed
(Montreal Cognitive Assessment)
10-15 min
30-item clinician administered
patient
Sensitive to MCI; covers multiple domains
Takes longer; requires certification to administer
Neurology; memory clinics; early diagnosis
(Mini-Mental State Examination)
7-10 min
30-item clinician administered
patient
Widely used; tracks cognitive change over time
Less sensitive to MCI
Primary care; neurology; longitudinal tracking
(registration required)
2-4 min
3-item recall and clock drawing
patient
Fast; good initial screen; includes executive function
Limited sensitivity; potential cultural bias
Primary care; annual wellness visits
<3 min
8-item informant questionnaire
PATIENT OR INFORMANT
Quick; good for early AD
Limited sensitivity to subtle forms of cognitive dysfunction
Primary care with care partner present; telehealth
(St. Louis University Mental Status Exam)
7–10 min
30-item clinician administered
patient
Detects MCI and dementia; adjusts for education level
Requires training; less known outside VA
VA settings; geriatrics; community clinics
MoCA (Montreal Cognitive Assessment)
10-15 min
30-item clinician administered
patient
Sensitive to MCI; covers multiple domains
Takes longer; requires certification to administer
Neurology; memory clinics; early diagnosis
MMSE (Mini-Mental State Examination)
7-10 min
30-item clinician administered
patient
Widely used; tracks cognitive change over time
Less sensitive to MCI
Primary care; neurology; longitudinal tracking
(registration required)
Mini-Cog©
2-4 min
3-item recall and clock drawing
patient
Fast; good initial screen; includes executive function
Limited sensitivity; potential cultural bias
Primary care; annual wellness visits
AD8®
<3 min
8-item informant questionnaire
PATIENT OR INFORMANT
Quick; good for early AD
Limited sensitivity to subtle forms of cognitive dysfunction
Primary care with care partner present; telehealth
SLUMS
(St. Louis University Mental Status Exam)
7–10 min
30-item clinician administered
patient
Detects MCI and dementia; adjusts for education level
Requires training; less known outside VA
VA settings; geriatrics; community clinics
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REFERRING TO A SPECIALIST
If the clinical assessment is consistent with AD, PCPs should discuss possible management strategies with their patients and consider referring to a specialist.12,13,24
HELPFUL ICD-10 AND CPT CODES
For a diagnosis of AD, consider the following codes26:
DIAGNOSIS CODE
G30.0
Early Onset
Typically diagnosed before age 65
G30.1
Late Onset
Typically diagnosed at or after age 65
G30.8
Other Ad
Other forms of AD
G30.9
Unspecified Ad
Used when the type of AD cannot be determined
G31.84
Mild Cognitive Impairment
For patients exhibiting cognitive decline with uncertain or unknown etiology
-11
for agitation
-18
for other behaviors such as sleep disturbances
-2
for psychotic DISTURBANCE
-3
for mood disturbance
-4
for anxiety
-0
Without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
For example, late-onset AD with mild dementia with agitation would be coded as:
- G30.1
- +
- F02.A
- +
- -11
CPT, Current Procedural Terminology; FDA, US Food and Drug Administration; ICD-10, International Classification of Diseases, 10th Revision.
For a diagnosis of AD, consider the following codes:
CPT CODE
DESCRIPTION
99483
Cognitive assessment and care plan13
96125
Standardized cognitive performance testing (eg, memory, attention, executive function)27
96116
Neuropsychological testing administered by a physician27
96132
Neuropsychological test evaluation services by physician or other qualified health care professional28
96136
Psychological or neuropsychological test administration and scoring (by physician or other qualified health care professional)28
96138
Psychological or neuropsychological test administration and scoring (by technician)28
97129
Therapeutic interventions that focus on cognitive function and strategies to manage performance of activities (first 15 minutes)29
Biomarkers
Specialists can help make a confirmatory diagnosis
As part of a full clinical evaluation, biomarkers allow for a confirmatory diagnosis early in the course of the disease, as evidenced by recent clinical practice guidelines from the Alzheimer’s Association Workgroup.30
Biomarkers that can assist with an AD diagnosis include30:
- Amyloid positron emission tomography
- Cerebrospinal fluid biomarkers for amyloid
- Recently FDA-cleared diagnostic blood test31
DID YOU KNOW?
Early diagnosis starts with proactively assessing patients’ cognitive health, so you can consider new management approaches that could help slow progression.1-3,23
Start addressing AD differently by uncovering different underlying pathways.
See what else could be driving AD development and progression.
- Alzheimer’s Association. 2024 Alzheimer’s Disease Facts and Figures. Accessed May 22, 2025. https://www.alz.org/getmedia/c65b6229-48cf-4a7b-a447-328fdf05e35d/alzheimers-facts-and-figures-2024.pdf
- Foster NL, Bondi MW, Das R, et al. Quality improvement in neurology: mild cognitive impairment quality measurement set. Neurology. 2019;93(16):705-713.
- Brunton S, Pruzin JJ, Alford S, Hamersky C, Sabharwal A, Gopalakrishna G. Perspectives of patients, care partners, and primary care physicians on management of mild cognitive impairment and mild Alzheimer’s disease dementia. Postgrad Med. 2023;135(5):530-538.
- Zhang J, Zhang Y, Wang J, Xia Y, Zhang J, Chen L. Recent advances in Alzheimer’s disease: mechanisms, clinical trials and new drug development strategies. Signal Transduct Target Ther. 2024;9(1):211.
- Zhang XX, Tian Y, Wang ZT, Ma YH, Tan L, Yu JT. The epidemiology of Alzheimer’s disease modifiable risk factors and prevention. J Prev Alzheimers Dis. 2021;8(3):313-321.
- Santiago JA, Potashkin JA. The impact of disease comorbidities in Alzheimer’s disease. Front Aging Neurosci. 2021;13:631770.
- Power MC, Willens V, Prather C, et al. Risks and benefits of clinical diagnosis around the time of dementia onset. Gerontol Geriatr Med. 2023;9:23337214231213185.
- Helvik AS, Engedal K, Šaltytė Benth J, Selbæk G. Time from symptom debut to dementia assessment by the Specialist Healthcare Service in Norway. Dement Geriatr Cogn Dis Extra. 2018;8(1):117-127.
- Cattel C, Gambassi G, Sgadari A, Zuccalà G, Carbonin P, Bernabei R. Correlates of delayed referral for the diagnosis of dementia in an outpatient population. J Gerontol A Biol Sci Med Sci. 2000;55(2):M98-M102.
- van Vliet D, de Vugt ME, Bakker C, et al. Time to diagnosis in young-onset dementia as compared with late-onset dementia. Psychol Med. 2013;43(2):423-432
- National Institute on Aging. What is mild cognitive impairment? Published 2024. Accessed May 7, 2025. https://www.nia.nih.gov/health/memory-loss-and-forgetfulness/what-mild-cognitive-impairment
- Alzheimer’s Association. 2019 Alzheimer’s Disease Facts and Figures. Accessed May 22, 2025. https://www.alz.org/getmedia/4be8a3fe-b60d-4349-b167-8db03b16e272/alzheimers-facts-and-figures-2019-r.pdf
- Alzheimer’s Association. 2025 Alzheimer’s Disease Facts and Figures. Accessed May 22, 2025. https://www.alz.org/getmedia/ef8f48f9-ad36-48ea-87f9-b74034635c1e/alzheimers-facts-and-figures.pdf
- Special Report: More Than Normal Aging: Understanding Cognitive Impairment. Alzheimer’s Association. 2022.
- DeTure MA, Dickson DW. The neuropathological diagnosis of Alzheimer’s disease. Mol Neurodegener. 2019;14(1):32.
- Hampel H, Hardy J, Blennow K, et al. The amyloid-β pathway in Alzheimer’s disease. Mol Psychiatry. 2021;26(10):5481-5503.
- Calabrò M, Rinaldi C, Santoro G, Crisafulli C. The biological pathways of Alzheimer disease: a review. AIMS Neurosci. 2020;8(1):86-132.
- Petersen RC, Lopez O, Armstrong MJ, et al. Practice guideline update summary: mild cognitive impairment [RETIRED]: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology. 2018;90(3):126-135.
- Bucholc M, Bauermeister S, Kaur D, McClean PL, Todd S. The impact of hearing impairment and hearing aid use on progression to mild cognitive impairment in cognitively healthy adults: an observational cohort study. Alzheimers Dement. 2022;8(1):e12248.
- The Medicare Learning Network. Medicare wellness visits. Updated November 2024. Accessed May 7, 2025. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/preventive-services/medicare-wellness-visits.html
- Alzheimer’s Society. Improving access to a timely and accurate diagnosis of dementia in England, Wales and Northern Ireland. Accessed May 7, 2025. https://www.alzheimers.org.uk/about-us/policy-and-influencing/improving-access-timely-accurate-diagnosis-dementia-england-wales-northern-ireland#:~:text=The%20headline%20consensus%20statement%20reads,all%20those%20living%20with%20dementia
- Rasmussen J, Langerman H. Alzheimer’s Disease—why we need early diagnosis. Degener Neurol Neuromuscul Dis. 2019;9:123-130.
- Smith B, Ownby RL. Disease-modifying treatments and their future in Alzheimer’s disease management. Cureus. 2024;16(3):e56105.
- National Institute on Aging. How is Alzheimer’s disease diagnosed? Published 2024. Accessed May 7, 2025. https://www.nia.nih.gov/health/alzheimers-symptoms-and-diagnosis/how-alzheimers-disease-diagnosed
- Atri A, Dickerson BC, Clevenger C, et al. The Alzheimer's Association clinical practice guideline for the diagnostic evaluation, testing, counseling, and disclosure of suspected Alzheimer's disease and related disorders (DETeCD-ADRD): validated clinical assessment instruments. Alzheimers Dement. 2025;21(1):e14335.
- Centers for Medicare and Medicaid Services. Billing and Coding: Cognitive Assessment and Care Plan Service. 2024. Accessed June 12, 2025. https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=59036
- Centers for Medicare and Medicaid Services. Billing and coding guidelines. https://downloads.cms.gov/medicare-coverage-database/lcd_attachments/31989_1/dl31990_psych017_cbg_040111.pdf
- American Psychological Association. Neuropsychological testing. 2018. Accessed May 7, 2025. https://www.apaservices.org/practice/reimbursement/health-codes/testing/neuropsychological-testing.pdf
- American Psychological Association. New codes to report cognitive function intervention services. 2020. Accessed May 7, 2025. https://www.apaservices.org/practice/reimbursement/health-codes/cognitive-function-intervention
- Jack CR Jr, Andrews JS, Beach TG, et al. Revised criteria for diagnosis and staging of Alzheimer’s disease: Alzheimer’s Association Workgroup. Alzheimers Dement. 2024;20(8):5143-5169.
- FDA clears first blood test used in diagnosing Alzheimer’s disease. FDA. Published May 16, 2025. Accessed June 12, 2025. https://www.fda.gov/news-events/press-announcements/fda-clears-first-blood-test-used-diagnosing-alzheimers-disease
