Primary care providers, including nurse practitioners (NPs) and physician assistants (PAs), are often the first point of care for patients presenting with concerns about memory loss. While major initiatives in the United States are aimed at improving diagnosis, results from a new study found that implementing a screening protocol is not sufficient enough to diagnose dementia or Alzheimer disease (AD). The full report is published in the Journal of the American Association of Nurse Practitioners.

“As the prevalence of AD is expected to increase and new, effective treatments are developed, there is a need to develop primary care services that detect AD earlier,” the researchers noted.

To understand why primary care clinicians may not routinely screen patients for AD, researchers identified peer-reviewed articles that identified organizational, provider, or patient characteristics of the primary care setting that influenced screening of AD. Empirical studies were included that identified factors for missed or delayed diagnosis, included a comparison of diagnostic accuracy by primary care providers, and identified organizational characteristics related to the diagnosis of AD. After exclusion criteria, a total of 7 articles were included; 2 interventional studies, 2 comparison studies, and 3 cross-sectional studies.

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Two studies compared the provider’s clinical judgment against a neuropsychological test battery while 1 study compared clinical diagnosis to autopsy results. The clinicians in these studies estimate of the prevalence of AD ranged from 6% to 51% and the accuracy of diagnosis between 19% and 81%. The most frequently cited organizational barrier to the detection of dementia was lack of services; the most widely cited provider barrier was lack of the provider’s ability to make the diagnosis (education). The study found that the most noted patient barrier to accurate diagnosis of dementia was the presence of confounding comorbidities or frailty.

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“Importantly findings from the current review indicate that additional interventions that improve support systems, increase services for individuals with AD and their families, and clarifying testing procedures may be a more critical step in achieving the goal of earlier diagnosis,” the authors concluded.


Romano RR 3rd, Carter MA, Anderson AR, Monroe TB. An integrative review of system-level factors influencing dementia detection in primary care. J Am Assoc Nurse Pract. 2020;32(4):299-305.