Clinical research continues to underscore the importance of early detection of cognitive decline, including conditions such as Alzheimer’s disease and related dementias. Yet timely and accurate cognitive assessment in primary care remains challenging. Most clinicians rely on brief, paper-based screening tools that are limited in scope and may lack standardization.
Digital cognitive assessments (DCAs) represent a growing opportunity to strengthen early detection and management of cognitive decline. These technology-based tools offer standardized, efficient, and potentially scalable approaches to evaluating cognitive functioning, support-
Clinician Awareness, Attitudes Toward, and Interest in Digital Cognitive Assessments for Cognitive Evaluation
Insights from Surveys by the American Academy of Family Physicians and the Gerontological Society of America
ing earlier intervention, monitoring more consistently, and improving coordination of care.
To better understand clinicians’ awareness of and experience and interest in using DCAs, the Global CEO Initiative on Alzheimer’s Disease (CEOi) partnered with the American Academy of Family Physicians (AAFP) and the Gerontological Society of America (GSA) to conduct parallel surveys of their memberships. Insights from these surveys reveal both the promise and the practical challenges of integrating DCAs into everyday clinical practice and identify key priorities for enabling broader adoption.
Key Findings
Reliance on Paper-Based Cognitive Assessment Tools
Despite growing attention to digital solutions, most clinicians continue to rely on traditional, paper-based tools for cognitive assessments. Nearly 9 in 10 AAFP respondents (88%) and nearly 8 in 10 (77%) GSA respondents report employing standardized paper assessments (e.g., Montreal Cognitive Assessment [MoCA], Mini-Mental State Examination [MMSE], or MiniCog). Only 3% of AAFP respondents and 13% of GSA respondents currently use DCAs to assess cognitive functioning.
Standardized paper assessments (e.g., MoCA, MMSE, Mini-Cog)
Asking patients explicitly about their thinking and memory
Interpreting impressions during patient or caregiver interactions
Referral to specialist
I do not routinely assess cognitive function
Digital cognitive assessments (e.g., BrainCheck, Linus)
Limited Familiarity and Experience with DCAs
Awareness of and hands-on experience with DCAs remain limited among clinicians. Only a small minority of AAFP and GSA respondents report being familiar with DCAs. Of those familiar, just 14% of AAFP respondents and 12% of GSA respondents have ordered and interpreted DCAs as part of a patient assessment.
Familiarity and Experience with DCAs
I have ordered and interpreted DCAs as part of a cognitive assessment
I have not ordered DCAs as part of a cognitive assessment, but I have reviewed results of DCAs ordered by another clinician
I have not used DCAs, but other clinicians
Perceived Challenges and Barriers to DCA Adoption
Clinicians report several challenges to implementing DCAs in routine practice. Both AAFP and GSA respondents rank several common issues highly, including lack of integration into electronic health records (EHRs), lack of clinical guidelines related to DCAs, and patient difficulty with technology.
Top Five Barriers to Using DCAs in Practice
GSA AAFP
Opportunities to Enhance Patient Care
Despite the barriers, clinicians recognize meaningful cases in which DCAs can be used to enhance patient care. Most respondents (97% for AAFP and 96% for GSA) say they would consider using DCAs when patients or caregivers report cognitive concerns, to support a diagnosis of mild cognitive impairment (MCI) or dementia, or for ongoing monitoring of cognitive function in patients with cognitive decline.
Top Three Opportunities for DCA Use in Practice
Interest in Using DCAs
Interest in using DCAs was assessed among respondents indicating they had ordered or reviewed results of DCAs or others in their practice use DCAs.
Respondents were permitted to check all that apply of 6 available response options, so percentages do not sum to 100%. The 3 most frequently selected options in each survey are summarized here.
Clinical Advantages of Using DCAs
Using DCAs offers a number of advantages. Respondents highlighted the value of having quantifiable data to guide decision making and enabling earlier detection of cognitive decline as benefits of using DCAs.
Top Benefits of Using DCAs in Clinical Practice
GSA
AAFP
Using DCAs in Remote Settings, Including at Home
Clinicians are open to using DCAs that can be completed remotely, in settings such as the home. Among survey respondents, 79% of those from AAFP and 65% of those from GSA report that they have not prescribed or recommended that patients complete DCAs in nonclinical settings but are open to it. The main concerns with remote completion relate to technology access, test accuracy, and how results integrate into clinical systems.
I do not currently use them, but I am open to it
do not currently use them, and I am not interested in using them
Respondents indicating currently use includes those reporting occasionally or regularly use. Due to rounding, the sum of percentages may differ from 100%.
Top Anticipated or Encountered Challenges in Remote or At-Home Administration of DCAs
Patient comfort or familiarity with technology
Concerns about test accuracy in unsupervised settings
Concerns about patient interpretation of results
Patient access to internet
Concerns about follow-up after results
Concerns about integrating results into medical record or EHR
Security or HIPAA concerns
I don’t see any challenges
Note: HIPAA = Health Insurance Portability and Accountability Act. Respondents were permitted to select up to 3 of 9 available response options, so percentages do not sum to
Information about DCAs That Clinicians Want to Have
Clinicians are eager for clear, practical guidance on how to integrate DCAs into patient care. The most common requests from respondents are for information on how DCAs integrate with EHR systems and current workflows, guidance on reimbursement and billing, and basic comparative information on available tools and evidence.
Conclusions
Most Common Requests for Information
Clinicians are ready and willing to adopt DCAs and need more support to do so. Key priorities for accelerating adoption include the following:
• Seamless incorporation into existing EHR and workflow systems.
• Guidance and consistency around coding, billing, and payer coverage.
• Practical training, continuing medical education (CME), and clinical guidelines to strengthen confidence in selecting and interpreting DCAs.
Additional Resources
For more information and resources on DCAs and how they can be integrated into clinical practice, visit www.alzdiagnostichub.org.
The GSA KAER Toolkit for Brain Health and other resources to support care teams to improve brain health care are available at geron.org/brainhealth.
