In 2015, the Gerontological Society of America (GSA) released a report on the detection of cognitive impairment and diagnosis of dementia (GSA, 2015). The report, developed by the GSA Workgroup on Cognitive Impairment Detection and Earlier Diagnosis (“GSA Workgroup”), underscored the value of detecting cognitive impairment and providing timely diagnostic evaluations for older adults. 

The report emphasized that various members of the primary care team, including physicians, nurse practitioners, physician assistants, and nurses, along with their office staff, play important roles in preventive care, diagnosis, and follow-up for individuals with dementia and their families.

The GSA Workgroup created a framework with four steps, each intended to improve health‐related outcomes and well‐being for people living with dementia and their families. The four steps—Kickstart, Assess, Evaluate, and Refer (KAER)—are designed to achieve greater awareness of cognition and brain health in older adults (Kickstart), increase detection of cognitive impairment (Assess), initiate earlier diagnostic evaluation (Evaluate), and make referrals for educational and supportive community services for people with dementia (Refer). 

GSA first published the GSA KAER Toolkit in 2017 and has continued to update the toolkit to accommodate changes to clinical evidence and the availability of new educational and clinical resources. This third edition, The GSA KAER Toolkit for Brain Health (i.e., KAER Toolkit) has been adapted for web-based use while preserving the key approaches for implementing the KAER framework. All content and design updates are made to enhance the toolkit’s usefulness for primary care teams, health professional educators and students, and others.

This toolkit provides practical approaches, educational resources, and validated clinical tools to help primary care teams implement the KAER framework as part of their efforts to support brain health and timely detection of and responses to cognitive impairment. The contents and selection of tools were developed with primary care teams as the principal audience. Others, including educators and students in disciplines such as medicine, nursing, and social work, may also find its contents useful. GSA recognizes that health care professionals outside the primary care setting also play a valuable role in detecting cognitive impairment (Chodosh et al., 2019).

This toolkit is divided into four primary sections to reflect each step of the KAER framework. The scope of information is curated for busy primary care teams in the following ways:

• Illustrations of early warning signs of cognitive impairment primarily focus on memory problems, which are the most common presenting complaint of people with cognitive changes. GSA acknowledges that memory concerns are just one symptom of cognitive impairment and that other symptoms such as unexpected functional impairment are also important considerations. Accordingly, the toolkit includes a variety of resources aimed at raising awareness of common signs of dementia beyond memory loss. 
• Information on different types of dementia is brief. GSA appreciates that conducting a differential diagnosis can be challenging and should involve a partnership between primary care teams and specialists who have expertise in this area of health care, when indicated.

Primary care teams have varying degrees of familiarity with dementia-related clinical processes and may operate in different types of structures, organizations, and geographic regions. As such, care team members who are considering using the KAER framework in their clinical workflows may find certain steps to be more relevant than others and are encouraged to adopt processes that make sense within their clinical context. The practice management section of the toolkit provides tools that may help providers with integrating these processes in their practices. 

In accordance with the Society’s ongoing efforts towards diversity, equity, and inclusion, GSA will continue to add resources that support primary care teams to address the needs of individuals from diverse and underserved communities. Researchers and clinicians are actively developing new approaches and tools to address cognition and brain health including resources to support primary care teams to better address diversity issues such as gender, race, ethnicity, culture, and language; low literacy; sensory impairments; and intellectual disabilities. For example, in 2024, GSA developed a companion document for the KAER Toolkit, Addressing Brain Health in Adults With Intellectual Disabilities and Developmental Disabilities, and a variety of Momentum Discussion podcast episodes that address diverse and underserved populations. These resources and others are described in this toolkit. GSA conducts ongoing environmental scans and will continually add resources to the KAER Toolkit as new information becomes available.

GSA has numerous resources addressing brain health, cognitive impairment, and Alzheimer’s disease and related dementias. These resources can be accessed on the GSA website. 

In this toolkit, the terms “person” or “individual living with dementia” are prioritized over “patient.” The purpose of these word choices is to remind readers that individuals with dementia and their families can have full lives without attaching stigma and misperceptions.

The terms “family,” “family member,” “friend,” and “caregiver” are used interchangeably to mean any relative, partner, friend, or neighbor who has a significant relationship in caring for the person experiencing or living with symptoms of dementia. 

Of note, the term “care partner” has recently been proposed to help improve the way people who provide care are viewed and to convey that those individuals are integral to the care of persons living with dementia who should have agency in their life as much as possible. However, the term “partner” may trigger other associations for many individuals. Therefore, the aforementioned terms will be used throughout this publication. 

The term “knowledgeable informant” refers to instances in which a family member or friend is able to offer useful information to the primary care team to inform the clinical history.

The term “mild cognitive impairment” refers to noticeable changes in memory and thinking that go beyond normal cognitive aging but are not as severe as dementia. Symptoms may include forgetfulness, difficulty finding words, trouble with complex tasks, and challenges in making decisions. However, people can usually perform activities of daily living and live independently. Mild cognitive impairment may be a precursor to dementia, but not all individuals with mild cognitive impairment will progress to dementia. 

The term “dementia” is an umbrella term that refers to a wide range of medical conditions caused by abnormal brain changes, with Alzheimer’s disease being the most common cause of dementia (Alzheimer’s Association, 2024). These changes can cause a decline in thinking and problem-solving skills (i.e., cognitive function) sufficient to interfere with daily activities. The changes can also affect behavior, feelings and emotions, and relationships.