Bridging Gaps in Dementia Care: PAs as Champions of Early Detection and Support 

November 19, 2025 

By AAPA Research 

Alzheimer’s Disease and related dementias (ADRD) present a uniquely complex challenge for patients, families, and healthcare systems. While public awareness of cognitive decline is growing, the journey from first concern to diagnosis and ongoing management remains fraught with barriers. Physician associates (PAs) are often patients’ first clinical touchpoints, uniquely positioned to initiate targeted conversations, conduct relevant testing, and guide patients and care partners through the maze of ADRD care. 

The Critical Importance of Early Diagnosis 
Early diagnosis in ADRD is not just about identifying the disease—it is about opening doors to timely intervention, planning, and support. When cognitive impairment is detected early, patients and families can access new therapies, participate in clinical trials, and make informed decisions about care and future planning. Early diagnosis also allows for the implementation of lifestyle modifications and support services that can slow the progression of ADRD and improve quality of life. 

However, the pathway to diagnosis is often fragmented. Patients may present with subtle symptoms, and families may be unsure where to turn. Time constraints, insurance hurdles, and limited access to specialists can delay workups and leave patients feeling lost. 

The PA’s Role: First Point of Contact and Care Pathway Guide 
Primary care providers are frequently the first clinicians to recognize cognitive changes, whether during annual wellness visits, chronic care appointments, or when patients or families raise concerns. PAs bring a practical, workflow-driven approach to ADRD care: 

• Screening and Initial Assessment: PAs routinely use cognitive screening tools such as MOCA, MMSE, and SLUMS, alongside laboratory tests to rule out reversible causes. These assessments are often integrated into annual wellness visits or prompted by family concerns. 

• Clinic Policy vs. Personal Initiative: While some clinics have formal protocols, many rely on the PA’s clinical judgment to initiate testing and follow up. PAs often function as the bridge between primary care and specialty services, referring patients to neurology or neuropsychology for further evaluation, and sometimes starting treatment when specialist access is delayed. 

• Patient and Family Education: PAs provide clear, actionable information about the diagnostic process, what to expect, and how to prepare for next steps. This includes discussing the spectrum of dementia, available tests (including imaging and biomarkers), and the importance of pacing assessments to avoid overwhelming patients. 

Navigating the Complex ADRD Pathway: Supporting Patients and Care Partners 
The journey from initial concern to diagnosis and ongoing management is rarely linear. Patients and families face barriers such as fragmented care, limited awareness of resources, caregiver strain, and financial challenges. PAs play a vital role in helping families navigate these obstacles: 

• Care Coordination and Patient Navigation: PAs, nurses, social workers, and dedicated navigators help guide patients through scheduling, follow up, insurance paperwork, and connections to specialists and community resources. Structured navigation programs have been shown to improve access to resources, care coordination, and quality of life, while reducing emergency visits and hospitalizations. 

• Empowering Care Partners: PAs normalize caregiver concerns, screen for caregiver stress, and some even connect families to respite care and counseling. They help anticipate future needs, such as safety at home, advance care planning, and long-term care options. 

• Ongoing Communication: Frequent check-ins with both patients and care partners are essential. PAs ensure that families feel heard, supported, and informed at every stage of the journey. 

Overcoming Barriers: Insights from PA Practice 
Focus group insights reveal that PAs face systemic, logistical, and educational barriers in delivering optimal ADRD care. Time constraints, lack of support staff, insurance limitations, and variable access to care coordinators and navigators are common challenges. Rural and underserved settings face additional hurdles, including inadequate transportation options and limited access to mental health services. 

Empowering PAs requires advocacy for greater autonomy, modernized practice laws, and access to practical resources. To that end, AAPA is working to provide PAs with high quality educational materials, such as handouts, toolkits, checklists, podcasts, microlearning videos.  

Telehealth is highlighted as a key strategy for improving access to specialists and supporting patients and caregivers, particularly in rural areas. 

Conclusion: The PA Impact 
PAs are at the forefront of ADRD care, initiating targeted conversations, conducting early screening, and guiding patients and families through the diagnostic and care pathway. By leveraging practical resources like the KAER Toolkit and DAC Brain Health Navigator, and advocating for supportive policies and education, PAs can reduce uncertainty, improve quality of life, and ensure that no patient or care partner navigates the journey alone. 

Early diagnosis is not just a clinical imperative—it is a compassionate commitment to supporting patients and families at every step. As healthcare evolves, PAs will continue to play a critical role in shaping the future of dementia care. 

Practical Resources for Clinicians 

• AAPA Clinical Resource Library  
  AAPA has aggregated educational and clinical resources related to neurology and brain health in one place. Clinical guidelines and point of care resources are now in one easy to find location. In addition, AAPA has toolkits available to support clinicians in identifying cognitive impairment in its initial stages and in recognizing, diagnosing, and treating patients exhibiting neuropsychiatric symptoms (NPS). Using the resources within the Cognitive Assessment Toolkit, PAs across specialties and practice settings will find the resources and develop skills they need to conduct cognitive assessments. As the number of patients living with dementia increases, the resources in the Neuropsychiatric Symptoms Toolkit help PAs recognize, diagnose, and treat patients exhibiting NPS.  
• KAER Toolkit
  The KAER framework—Kickstart, Assess, Evaluate, Refer—offers PAs a stepwise approach to ADRD care, from the initial brain health conversation to referral. It provides practical guidance for structuring the pre-diagnosis to diagnosis stages, including screening, assessment, and referral. The toolkit helps PAs navigate the complexities of ADRD care and ensures that patients and care partners receive clear, actionable support. 
• DAC Brain Health Navigator
  The DAC Brain Health Navigator provides tools and resources for implementing a dedicated navigator role within institutions. It includes workflow integration guidance, a business case for adoption, and training materials to support PAs and other clinicians in delivering coordinated, patient-centered care. By integrating these resources, practices can enhance support for patients and families, streamline care coordination, and improve outcomes.

You May Also Like 
Vital Rounds: A microlearning video series: In this four-part series, Neurology PA Jordan Mast explores the role of patient navigation in Alzheimer’s care—highlighting barriers, the benefits of structured navigation programs, and how PAs can lead at every step of the journey. Viewers will gain practical strategies for diagnosis, care planning, and caregiver support that improve outcomes and quality of life. 

About The Project 
Eisai sponsored this research. The research is the work of AAPA, including the focus group and the conclusions drawn.  

Noël Smith is AAPA’s Senior Director of PA and Industry Research and Analysis. She can be reached at [email protected].