September was World Alzheimer's Month, the annual awareness campaign led by Alzheimer's Disease International (ADI), and the 2026 theme was "The earlier you know, the more you can do: a dementia diagnosis matters."
The second half of that theme, what is already possible or may become possible once cognitive decline is identified, has expanded in recent years. The 2026 Alzheimer's disease drug development pipeline includes 158 agents in 192 active trials, up from 138 agents in 182 trials a year earlier, and the anti-amyloid therapies already approved are indicated for the early symptomatic stages of Alzheimer's disease. Earlier identification also facilitates clinical work care teams can begin now, from addressing conditions that may be contributing to cognitive symptoms to reviewing medications and planning care with the patient and family.
Those options depend on progress in detection as well, since most of them are available only when cognitive decline is identified early. An analysis of Medicare claims from 226,756 primary care clinicians estimated that, on average, about 8% of expected mild cognitive impairment (MCI) cases were diagnosed. For primary care teams and the health system leaders who support them, the sections below cover what earlier detection requires in routine care, what a care team can begin once a result is in hand, and how that work scales across a network.
Article Highlights
Earlier detection in routine care depends on assessment reaching patients where they already are, performing accurately across the populations being screened, and registering cognitive change while it is still subtle. How well those conditions are met varies widely by setting.
The memory clinic at Texas Tech University Health Sciences Center serves more than 40 counties across 4 states, in a region federally designated as medically underserved, where cognitive screening had been largely absent from routine care. The clinic team brought screening to public libraries, senior centers and community halls, and screened more than 600 people in about a year.
About 1 in 4 were flagged for possible cognitive impairment, most at early stages, and the team follows up at 1 and 3 months to see whether those patients have engaged in care. Without routine screening, impairment in communities like these is more likely to be recognized later, when stage-dependent options such as anti-amyloid therapy and early-stage clinical trials may no longer be available.
Claremedica provides value-based primary care to a culturally and linguistically diverse Medicare Advantage population across more than 35 sites in Florida. Traditional screening tools had created cultural and language barriers for some of those patients, and the practice moved to the Creyos digital cognitive assessment, which includes shape-based tasks and supports multiple languages. Claremedica subsequently completed more than 34,000 assessments in 7 months.
More than 90% of newly identified patients were at early or mild stages, and more than 80% had been patients of the practice for years and had been screened before with traditional tools. Where assessment reaches patients and performs consistently across the population, more of them arrive at the next stage of care while more care and treatment options are still open.
Patients and families place real weight on what a diagnosis makes possible. In the World Alzheimer Report 2024, which drew on more than 40,000 responses across 166 countries, more than 90% of carers and members of the general public said they would be encouraged to get a diagnosis if a disease-modifying treatment were available. Much of what an earlier result opens up is available in primary care now, and it can begin in the weeks after an abnormal screen.
A 3-part series by Dr. Anthony Zizza, a board-certified geriatrician and Chief Medical Officer at Element Care and Clinical Advisor at Creyos, sets out his approach to that work for primary care teams:
Most people living with dementia receive their ongoing care in primary care, which can position the care team to begin management while any referral is pending. The first 30 days may start with ruling out an urgent cause, then confirming the concern, staging it by daily function, looking for reversible or modifiable contributors, and reviewing medications with cognition in mind.
By day 30, a first care plan can identify a care partner and address safety, including driving, falls, medication administration and financial exploitation. Families often sense whether a clinician is ready to name the problem and propose next steps, and a concrete plan signals that the practice will stay involved.
Older adults with cognitive impairment often take several medications, and different drug classes can affect cognition in different ways. Some act against the cholinergic signaling that symptomatic Alzheimer's medications aim to support, while others, such as sedatives and some sleep aids, can add to drowsiness, confusion and fall risk. Reviewing the full medication list can be an important part of early management.
A structured 7-step medication review, worked through with a case example, treats the medication list as a treatment target in its own right, changing one or two things at a time and reassessing cognition and function afterward.
How a diagnosis is delivered can shape how patients and families engage with the care that follows. Dr. Zizza's approach to the diagnosis conversation centers on speaking to the patient directly, with a care partner present when the patient wants one, using plain language and tailoring the conversation to stage.
The conversation can follow 6 steps (prepare, ask, name, pause, plan and return), with disclosure treated as a process across visits. Delivered early, it allows patients to take part in decisions about who will speak for them later in their care journey and what matters most.
Confronting the Dementia Crisis gathers this material in one place for primary care teams, alongside best practices in screening and diagnosis and guidance on evaluating the tools that support them.
The World Alzheimer Report 2026, released on World Alzheimer's Day, focuses on clinical trials, and its conclusions reach into routine care. The report finds that "the science is advancing faster than the systems required to support it," and that for millions of people, diagnosis "remains late, inconsistent, or entirely inaccessible." Its first recommendation to governments is to invest in national diagnostic capacity and early detection pathways.
The report notes that high-income countries face the same capacity problem, with specialist memory services overwhelmed and referral pathways slow. Among more than 160,000 Medicare participants referred to a neurologist in the US, the wait for a first visit was about 34 days, and nearly 1 in 5 waited more than 90 days.
Moving assessment into primary care at network scale is largely an operational question. When one large multi-state health network made that shift, the rollout involved coordinating with more than 30 teams, from primary care and specialty divisions to finance, IT and compliance. The resulting workflow lets patients complete a tiered screen before their visit, with results waiting in the electronic health record for physician review. Breaking the Bottleneck sets out that blueprint, along with the financial case under fee-for-service and value-based care.
The challenge for the next decade will therefore be twofold: discovering better treatments while ensuring health systems are capable of diagnosing patients early enough to benefit from them. A breakthrough drug means little if the majority of people living with dementia are never identified in the first place.
— World Alzheimer Report 2026, Alzheimer's Disease International
World Alzheimer's Month closes each September, and the work its 2026 theme describes continues year-round in routine care. Much of what determines how early cognitive decline is identified, and how much a care team can do once it is, sits in primary care and in the pathways health systems build around it.