NeuroTrax Science Team and Glen M. Doniger, PhD

Cognitive health is increasingly recognized as a core component of preventive care, yet routine cognitive assessment remains inconsistently implemented in primary care. Medicare’s Annual Wellness Visit (AWV) was designed to create a structured opportunity for cognitive screening, but recent national data reveal a persistent gap between policy intent and practice. A 2025 nationally representative survey found that although 80% of beneficiaries reported ever having an AWV, only 31% underwent formal cognitive testing during their most recent visit, and higher-risk individuals were not more likely to receive structured assessment [1]. These findings indicate that structured cognitive testing did not increase with AWV uptake and that individuals at elevated risk were not more likely to be formally assessed.

Regular cognitive assessment is important not only for early detection of mild cognitive impairment or dementia, but also for identifying reversible contributors such as medication effects, depression, metabolic abnormalities, sleep disorders, or cardiovascular risk factors. Even when neurodegenerative disease is suspected, earlier identification allows for timely intervention, risk reduction strategies, care planning, and access to emerging therapies that are most effective in early stages. Routine measurement also enables longitudinal tracking, helping clinicians distinguish normal aging from accelerated decline and providing patients and families with objective data rather than uncertainty.

Implementation research demonstrates that AWV delivery is shaped by multilevel structural and behavioral factors, including workflow integration, EHR prompts, provider confidence, reimbursement clarity, and organizational readiness [2]. A 2025 scoping review guided by the Consolidated Framework for Implementation Research (CFIR) identified vague CMS guidance, limited reimbursement, staffing shortages, workflow misalignment, and provider discomfort with cognitive screening as persistent barriers [2]. Successful implementation depended on structured workflows, training, leadership support, and integrated infrastructure [2].

Together, these findings suggest a need to move beyond opportunistic or loosely structured screening toward routine, standardized neuromarker-based cognitive measurement.

NeuroTrax provides a domain-specific computerized cognitive battery that quantifies memory, executive function, attention, information processing speed, visual spatial ability, verbal function and motor skills using age- and education-adjusted norms. Unlike informal questioning or brief screens, digital neurometrics enable detailed baseline characterization, longitudinal tracking, and objective change detection. Incorporating such tools within AWVs aligns with the implementation facilitators identified in primary care systems, namely EHR integration, team-based workflows, and structured documentation processes [2].

Preventive care routinely monitors blood pressure, lipids, and glucose with standardized metrics. Cognitive wellness should be treated with similar rigor. As national evidence shows that AWV uptake alone does not guarantee structured cognitive evaluation [1], integrating objective digital neuromarkers like NeuroTrax into routine workflows may close the gap between policy and clinical practice, enabling regular brain health monitoring and earlier detection of decline.

References:

[1] Liu, Y., Ozawa, T., and Mattke, S. (2025). Usage patterns of cognitive assessments during Medicare’s Annual Wellness Visit: A national survey. Alzheimer’s & Dementia, 21:e14539. DOI: 10.1002/alz.14539.

[2] Okpalauwaekwe, U., Franks, H., Kuo, Y.-F., Raji, M.A., Passy, E., and Tzeng, H.-M. (2025). What helps or hinders Annual Wellness Visits for detection and management of cognitive impairment among older adults? A scoping review guided by the Consolidated Framework for Implementation Research. Nursing Reports, 15:295. DOI: 10.3390/nursrep15080295.