Why Cognitive Screening Should Be Routine in Primary Care: A Conversation with Anna Chodos, MD

In honor of World Brain Day, Patient Care spoke with Anna Chodos, MD, a professor in the division of geriatrics at the University of California, San Francisco, and the executive director of Dementia Care Aware, about the critical role primary care physicians (PCPs) play in the early detection and management of cognitive decline. With dementia prevalence on the rise, Dr Chodos outlines why screening must become as routine as checking blood pressure and how a proactive “brain health plan” can help preserve cognitive function, reduce caregiver strain, and improve long-term outcomes for older adults.

The following transcript has been edited for flow, style, and clarity.

Anna Chodos, MD, MPH

Photo courtesy of Dementia Care Aware

Patient Care Online: Why is it important for PCPs to prioritize early detection of cognitive decline during routine visits with their older patients?

Dr Chodos: It’s a great question. The momentum in primary care has not traditionally centered around screening because we follow guidelines from organizations that set screening practices. But the tide is turning when it comes to early detection of dementia. We’re seeing that shift in policy and in clinical care.

And the reason is clear: there’s a lot we can do early on to improve brain health and slow the progression of dementia. Early detection also gives people critical time to plan—legally, socially, medically—with their families or support systems. The two big reasons are better clinical outcomes and practical planning for the future.

Patient Care Online: What do we know about how early identification impacts patient outcomes and the burden on caregivers?

Dr Chodos: We know that identifying dementia early improves quality of life and reduces caregiver strain. The data are strongest on how early interventions—like correcting hearing or vision loss or adjusting medications that negatively affect cognition—can slow decline. Many medications taken in middle age have cognitive side effects that show up later in life, especially when dementia begins.

Also, if I know someone has dementia, I’ll care plan differently. I’ll structure medications to be easier to manage, and I’ll connect patients to appropriate services. Much of the benefit is practical, but the data also show meaningful improvement in caregiver burden and perceived quality of life.

Patient Care Online: What simple steps can primary care physicians take to make cognitive screenings as routine as checking blood pressure?

Dr Chodos: We recommend using brief screening tools that can be administered by anyone on the care team. In one clinic we work with, medical assistants ask questions during triage, like, “Have you noticed any changes in your thinking?” and “Do you need more help with day-to-day activities like shopping or cleaning?” That’s a quick cognitive and functional screen—before the provider even sees the patient.

The electronic health record is also key. If you build a reminder into the system, it can prompt annual screening and track who has been screened. Importantly, if a person already has a dementia diagnosis, you can turn off the screening prompt for them.

Patient Care Online: Is there a typical age at which screening should begin?

Dr Chodos: We recommend starting at age 65. It’s a bit arbitrary—largely driven by Medicare—but the data support it. Dementia risk increases in the 60s and becomes much higher by the 80s, when about half of people will have mild cognitive impairment or dementia.

But context matters. If you’re serving a socioeconomically disadvantaged population, risk factors can appear earlier. For example, in my practice, many patients experiencing homelessness show cognitive decline beginning in their 50s. So you need to tailor your approach to the population you serve.

Patient Care Online: What are some helpful ways to start conversations when cognitive decline is suspected?

Dr Chodos: That’s a great question, and I think this is one of those smaller but meaningful barriers—just not feeling comfortable bringing it up.

Making screening routine helps. You can say, “Now that you’re this age, the right thing to do is to make sure your brain is healthy. Would it be okay if I asked you a few questions or did a quick screen?”

I also recommend tying it to observations. “I’ve noticed you’re having a little more trouble managing medications. That could be a sign we should check in on brain health.”

There are two ways to approach it: either from a specific concern, like missed appointments or memory complaints, or as a standard proactive check, the same way we screen for blood pressure or heart health.

Patient Care Online: With dementia cases on the rise, how do you see the role of the primary care physician evolving?

Dr Chodos: It’s absolutely critical. We don’t have a plan for a massively expanded specialized workforce, so general practitioners will see more patients with cognitive symptoms. Their role must be proactive.

This aligns with what patients and caregivers want—early detection. We also want clinicians to use available tools, like those from Dementia Care Aware, to feel comfortable doing the workup and reaching a diagnosis. You don’t need perfect diagnostic tools; you need to recognize the syndrome of cognitive and functional decline, which defines dementia.

The tools and roadmap help clinicians feel more confident talking with patients and starting care and support plans early.

Patient Care Online: Is there anything else you’d like our audience to know?

Dr Chodos: I’ve been fortunate to build a focus on dementia into my practice, and I’ve developed a real passion for this work. Dementia is so common and life-altering that every time we recognize it and help patients name it, we make a difference.

Primary care physicians already build trust with patients—this is an opportunity to deepen that. The idea that “there’s nothing we can do” is outdated. In reality, there’s a lot we can do with a brain health plan.

This includes controlling vascular risk factors (like blood pressure, LDL cholesterol, and diabetes), encouraging physical and social activity, reviewing medications that impair cognition—especially anticholinergics—and correcting sensory loss.

Vision issues are often easy to address. Hearing loss is harder—there’s stigma, cost, and adjustment—but it has a huge impact. Randomized trials show that correcting hearing improves cognition and slows decline. I’ve seen patients get motivated to stick with hearing aids because they understand it’s good for their brain.

If a patient shows symptoms or screens positive, don’t wait—start a brain health plan. It can make a real difference in preserving long-term cognitive function.