• Index Visit/Initial Signs

    An index visit is any visit in which the patient or family member of the patient identifies a specific memory issue of the patient, the health care provider recognizes signs of cognitive impairment, or an annual wellness visit triggers concern. Specific assessments are discussed in the next sections.

    These resources represent current best practices and clinically relevant information. Work is actively being done to create resources that better account for cultural background, social determinants of health, and other factors that can help prevent cognitive impairment.

    Suggested Physician Resources

    Assessing Cognitive Impairment in Older Adults
    Provided by the National Institute on Aging, this resource is a guide for physicians to help assess and screen for cognitive impairment in your patients.

    Spotting the Signs of Mild Cognitive Impairment
    The American Psychological Association provides this 2019 Continuing Education article (12-minute read). Learning objectives focus on mild cognitive impairment, criteria for diagnosis, as well as prevention and treatment.

    Mild Cognitive Impairment
    This 2018 resource from the American Academy of Neurology articulates clinical recommendations for evaluating patients with MCI for modifiable risk factors, assessing and treating behavioral/neuropsychiatric symptoms, and monitoring patient cognitive status over time. 

    Annual Wellness Visit (AWV)
    The Annual Wellness Visit (AWV) is a Medicare benefit added through the Patient Protection and Affordable Care Act. The AWV focuses on long-term preventive care. Detection of cognitive impairment is a component of the AWV. This resource provides information on the AWV benefit, eligibility, required components, and coding and billing specifics. AAFP members can access our easy-to-read supplement on AWVs here.

    Family or Caregiver Questionnaire
    As a practical tool, the Family Questionnaire can be used in clinic visits to help identify someone with memory problems that might otherwise go unnoticed. It consists of five questions. A family member or friend can complete the questionnaire in less than a minute. It was designed by the National Chronic Care Consortium and the Alzheimer’s Association. This brief questionnaire could be appropriate when a family/friend is part of the patient’s clinical visits, like the Annual Wellness Visit.

    Patient, Family, and Caregiver Resources

    Forgetfulness: Knowing When to Ask for Help
    The National Institute on Aging developed a 4-page patient and family resource that addresses a common symptom of aging: forgetfulness. This guide addresses the causes of memory loss, offers tips for keeping the memory sharp, and discusses actions that can be taken to follow up on concerns. The resource is available to print or order online and has a Spanish version.

    10 Warning Signs of Alzheimer’s
    The Alzheimer’s Association has a patient and family handout called the “10 Early Signs and Symptoms of Alzheimer’s”. This worksheet can help people know when and what to bring up with their health care team.