As busy family physicians and primary care clinicians, we manage multiple comorbidities, track evolving clinical guidance, and work to translate new evidence into daily practice. When yet another test or recommendation appears on our radar, the natural reaction is caution. We want the best outcomes for our patients, and we have to balance that against the realities of a packed schedule and a team-based workflow that is already stretched.
Even with these pressures, cognitive assessment belongs near the top of that priority list. Fortunately, the way we approach the evaluations today can fit into our practices without adding burden. The growth of the senior population, the strength of the evidence behind early detection, and the maturation of AI-enabled tools designed for primary care have changed what is possible. We now have the opportunity to engage technology and evidence-based interventions to efficiently integrate this work into a team-based workflow.
An estimated 6.9 million Americans aged 65 years and older are living with Alzheimer’s dementia, and up to 22 million have some memory or cognitive deficit that remains undiagnosed. Likewise, 96% of primary care physicians think it is important to assess patients aged 60 and older for mild cognitive impairment (MCI). Yet fewer than half of patients in this age group actually receive routine cognitive assessments.
That gap is not a reflection of the clinician’s disinterest, but rather the constraints we work within. Cognitive conversations take time, surface complex emotions, and often arise alongside diabetes, hypertension, and cancer prevention items packed into a 20-minute visit agenda. For our specialty, the question has evolved from brain health’s role in primary care to how we incorporate it in ways that support our teams and our patients.
As my colleagues know, MCI may or may not come with noticeable symptoms. A patient or family member may not realize anything is wrong, and we may have only a fleeting moment in a visit to notice subtle change. Yet this early window is precisely when we have the most options to offer.
Identifying cognitive change earlier allows us to evaluate reversible causes such as thyroid dysfunction, vitamin deficiency, sleep disorders, polypharmacy, and depression. It enables us to recommend lifestyle changes to optimize brain health and slow disease progression, including physical activity, cardiovascular risk management, social and cognitive engagement, and sleep quality. It opens the door for patients who may be eligible for genetic testing, newly available medications, or clinical trial participation, if interested. Perhaps most importantly, the early detection gives patients and families time to plan, which is often what they tell us they wish they had been given.
Earlier identification also reframes the conversation. When we approach brain health the way we already approach heart disease and diabetes risk, as something to monitor and address over time, we move from crisis response to preventive care. That is much more aligned with how family medicine thinks about whole-person health across the lifespan.
When I talk with colleagues about adopting new tools, three questions come up almost every time:
Is it evidence-based?
Will it improve the care and outcomes of my patients?
Can I provide it equitably across my patient panel?
Cognitive assessment, done well with the right tools, can answer yes to all three.
The evidence base is now substantial. Peer-reviewed research demonstrates that AI-enabled digital cognitive assessments can surface signals associated with Alzheimer’s pathology years before patients or families detect change. Recent studies show that brief digital assessments analyzed using AI are associated with underlying amyloid and tau changes in the brain, even in people who appear cognitively normal. That kind of quantifiable, objective data is what makes earlier conversations feel grounded rather than speculative.
The impact on care is tangible. Digital cognitive tools capture hundreds of meaningful data points beyond what a paper-based test and observation can gather. They can be administered by a medical assistant or nurse on a tablet during a routine visit and scored automatically, freeing the physician's time for the conversation that follows. The result is a clearer picture of the patient in front of us, more confident clinical decision-making, and faster, more accurate triage to specialty care when needed.
The equity question is one I take seriously. I have practiced in rural communities and underserved urban settings throughout my career, and I know firsthand how long the wait can be for a neurology or neuropsychology referral. AI-enabled assessments help extend specialist expertise into the settings where it is hardest to access. When primary care teams can do more of the initial workup using objective data, patients who genuinely need specialty evaluation reach it sooner, and those who do not can be supported and monitored in the medical home they already trust.
The traditional cognitive tools many of us were trained on, including the Mini-Cog, Mini-Mental State Examination, and Montreal Cognitive Assessment, have established norms and remain familiar. They also have known limitations, including documented inconsistencies and biases in the paper-based formats, and they often require dedicated physician time to administer and score.
Digital cognitive assessments build on the most reliable, evidence-based aspects of these tools and use AI to enhance sensitivity and objectivity. They run on familiar hardware like digital tablets, fit within an annual wellness visit or routine appointment, and produce structured reports that flag patients who may need closer follow up or additional testing, such as blood-biomarker tests for Alzheimer’s disease. Assessments can be administered by a medical assistant, which makes the workflow genuinely team-based. The physician’s time is preserved for the conversation, the care plan, and the bidirectional communication with subspecialty colleagues that ongoing quality care requires.
For our patients, the experience is brief, low-stress, and built into a visit they were already coming in for. For our practices, it adds capacity rather than consuming it.
I would not have imagined this level of capability even five or ten years ago. When I was earlier in practice, addressing cognitive concerns proactively in a short visit often felt unfeasible. The fact that we now have evidence-based digital tools that support earlier conversations about brain health, long before dementia is present and when we can still do something about it, represents a meaningful shift for primary care and for the patients we serve.
I encourage colleagues to learn more about digital cognitive assessments, examine the science that validates them, and consider how they might fit into your practice workflow. Brain health is the next frontier of preventive care. With the right tools and a team-based approach, we can lead that work from where we already are, which is at the front line of our patients’ lives.
Written by Julie Wood, MD, MPH, FAAFP.
Julie is the Senior Medical Director of Clinician Engagement at Linus Health, where she leads efforts to help clinicians adopt digital cognitive assessments and AI-enabled tools in everyday practice. A board-certified family physician with experience across public health, clinical strategy, and primary care transformation, she previously served as Senior Vice President for Science and Clinical Strategy at the American Academy of Family Physicians. At Linus Health, Dr. Wood focuses on partnering with care teams to support earlier detection of cognitive impairment, strengthen workflows, and advance more proactive brain health care.