Abstract

Dementia remains under-detected in primary care despite recommendations to assess cognitive health during Medicare’s Annual Wellness Visit (AWV). Persistent gaps in clinician knowledge and workflow standardization contribute to delayed diagnosis and missed opportunities for early intervention. Strengthening early detection practices is essential to improving outcomes for individuals with dementia. This project aimed to improve early detection of dementia by implementing a brief clinician education program and evaluating its impact on dementia knowledge, mild cognitive impairment (MCI) diagnostic coding, and utilization of the Cognitive Assessment and Care Planning Visit (CACPV). The DNP (Doctor of Nursing Practice) project was conducted in two Arizona primary care clinics. Study I assessed changes in dementia knowledge among healthcare professionals using pre- and post-intervention surveys (N=17 pre; N=10 post). Paired t-tests were used to evaluate differences in Dementia Knowledge Assessment Scale (DKAS) scores. Study II examined changes in MCI coding and CACPV utilization using two-proportion Z tests across 2,423 Medicare AWVs before and after the intervention. In Study I, dementia knowledge significantly improved in the full sample, t(9)=2.70, p=.02, with a small-to-medium effect size (d=0.49). In Study II, MCI coding increased from 0.56% pre-intervention to 1.12% post-intervention, although the difference was not statistically significant (Z = -1.49, p = .14). No CACPV utilization occurred before or after the intervention. Integrating targeted education into primary care workflows may strengthen early detection efforts and align practices with state and national dementia care.

Author Details

Terry Elaine Smith, DNP, RN, FNP-C. Dr. Smith has been a nurse for 30 years and an FNP for the last 12. She is currently in private practice in Flagstaff, AZ and also serves as an Associate Clinical Professor at Northern Arizona University.

Sigma Membership

Lambda Omicron

Type

DNP Capstone Project

Format Type

Text-based Document

Study Design/Type

Quality Improvement

Research Approach

Quantitative Research

Keywords:

Dementia, Early Diagnosis, Diagnosis of Dementia, Primary Health Care, Primary Care, Cognitive Screening, Medical Screening, Cognitive Testing, Mild Cognitive Impairment

Advisor

Dawn Rivas

Degree

DNP

Degree Grantor

Northern Arizona University

Degree Year

2026

Rights Holder

All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.

Review Type

None: Degree-based Submission

Acquisition

Self-submission

Date of Issue

2026-05-21

Full Text of Presentation

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