The following is a summary of “Understanding barriers to and facilitators of clinician-patient conversations about brain health and cognitive concerns in primary care: a systematic review and practical considerations for the clinician,” published in the November 2023 issue of Primary Care by Borson, et al.
Identifying cognitive impairment, especially Alzheimer’s disease or related dementias (ADRD), falls within the purview of primary care clinicians (PCCs). However, initiating discussions on cognitive changes poses challenges for patients, families, and clinicians, hindering the incorporation of brain health conversations into routine healthcare. Understanding the barriers and facilitators in primary care settings is crucial to establishing this as a standard of care. For a study spanning January 2000 to October 2022, researchers explored perceptions of cognition and provider-patient brain health conversations.
A systematic search of PubMed, Scopus, Web of Science, and the Cochrane Library targeted US-based qualitative or quantitative studies assessing cognition perceptions and brain health conversations before formal screening or diagnosis of mild cognitive impairment or ADRD. The Mixed Methods Appraisal Tool evaluated study quality.
Among 5,547 abstracts, 22 articles (19 studies) were included. Four main themes emerged from examining cognition perceptions and provider-patient interactions: PCC hesitation in discussing brain health, patients’ reluctance to raise cognitive concerns, inadequate communication of evidence guiding treatment plans, and the impact of social and cultural context on perceptions of brain health and cognition.
The rarity of early brain health conversations in primary care highlighted the need for effective tools, processes, and strategies to integrate these discussions routinely. Recognizing and addressing these barriers can enhance clinical engagement, facilitating timely interventions in cognitive health.