Raise the topic of brain health and continue the conversation over subsequent visits.

Brain health as an important aspect of overall health should be addressed with patients during any office visit, including the Medicare Annual Wellness Visit.  

Raising the topic of brain health will help normalize discussions about it, encourage individuals to be more aware of changes to their cognition or other brain health–related changes, and create an environment where patients may feel more comfortable sharing their concerns. Many people are reluctant to express such concerns because of fear and stigma often associated with loss of cognitive abilities and dementia, and they may feel it is the clinician’s role to raise the issues (Borson 2023). While there are likely others (e.g., family members) who observe cognitive changes and other symptoms, the private and autonomous nature of health care makes it challenging to share those concerns with a provider.

“Raising the topic of brain health will help normalize discussions about it.”

Frank yet sensitive conversation about brain aging can be initiated using key messages about brain aging:

  • The brain ages, just like other parts of the body.
  • Cognitive aging is not a disease; it is a natural, lifelong process that occurs in everyone.
  • Cognitive aging is different for every individual.
  • Some cognitive functions improve with age. 
  • Dementia is not a normal part of aging and is different from cognitive aging. 
  • Even if individuals do not express concerns, health care team members can use a brain health conversation to share important information about how medications can affect the brain, the connection between a healthy heart and a healthy brain, and lifestyle habits that can support a healthy body and brain.

Practice Pearl | Kickstarting a Brain Health Conversation

Soo Borson, MD, Co-lead, BOLD Public Health Center of Excellence on Early Detection of Dementia

Professor, Clinical Family Medicine University of Southern California


One way to start the conversation with patients about brain health is to state, “Our practice is working to improve our care of older adults. One way we're doing this is by making brain health a priority! Brain health refers to memory and thinking, mood, connections with others, and things you do for your own health, like watching your diet and staying physically active. I'd like to ask you a few questions about your brain health. Do you have any concerns right now? Have you noticed any changes in your memory or thinking?"

This initial screening can be performed by various team members, including medical assistants, who can share information with the primary care providers. In other practices, nurses perform screenings for cognitive concerns.

Resources to Support Discussion

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Conversations about brain health can be initiated based on the Institute of Medicine’s Cognitive Aging: Progress in Understanding and Opportunities for Action and the McKnight Brain Research Foundation’s Cognitive Aging Explained.

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A GSA Momentum Discussion Podcast episode, Enhancing Early Detection of Cognitive Impairment, highlights approaches aimed at early detection of cognitive impairment in the primary care setting and underscores how providers can use tools in this section to enhance their early detection efforts and help to improve outcomes for older adults with cognitive impairment and their caregiver.

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Other useful resources include a video from the Alzheimer’s Association, Visit 1: Assessing Cognition and Recommending Follow-Up, and Navigating Pre-Screening Conversations from the BOLD Public Health Center of Excellence for Early Detection of Dementia that offers simple steps to ease difficulties related to conversations about cognition.

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See the Resources for Patients About Brain Health page for educational materials to share with patients about brain health.