The objectives of Step 1 of the KAER framework—K for Kickstart—are to increase people’s awareness of the importance of brain health and to assist the primary care team, including office staff, in detecting signs and symptoms of cognitive impairment that may lead to further evaluation.

Many people who meet the diagnostic criteria for Alzheimer’s disease and other dementias are not diagnosed or are unaware of their diagnosis. For example, in an analysis of Medicare claims, dementia was undiagnosed in 39.5% of beneficiaries who were likely to have the condition based on additional claims data (e.g., functional status, social/behavior characteristics, healthcare utilization); 31.8% of people who were diagnosed (or their proxies) were unaware of the diagnosis (Amjad, 2018). People were more likely to be undiagnosed if they were Hispanic, had less than a high school education, attended medical visits alone, or had fewer functional impairments (Amjad, 2018). Thus, there are several gaps in ensuring that people with cognitive impairment receive a diagnostic evaluation and have information about the diagnosis disclosed to them. Having conversations with people about their brain health is an important step toward addressing these gaps.