Background 

Primary Care (PC) is the main source of care for adults at risk for dementia. Scalable approachesguiding care remain limited. Wedeveloped the PC Brain Health Navigator (BHN) program during our Davos Alzheimer’s Collaborative Healthcare System Preparedness implementation andimproved adherence to evidence-based care.1We evaluated feasibility of facilitatingimpairment-risk based referrals using a PC BHN. 

Methods 

 A PC BHN program was implemented in three health-system regions (June 2022-December 2025). PC providers referred patients for abnormal brief cognitive screening or subjective concerns. The BHN used a clinical algorithm to guide pathway recommendations.  

Results 

Patients:Of 2,046 eligible patients, 402(19.7%) completed a BHN visit. 98.0% (393/402) completed additional cognitive screening, 85.0% received a preliminary functional diagnosis (subjective cognitive concerns, MCI, or dementia syndrome), and 53.5% completed MRI. Addressable factors were common (elevated risk scores:depression (PHQ-9)(17.2%), anxiety(GAD-7) (11.2%), anticholinergic (22.6%), cardiovascular (ASCVD) (92.4%)).37/215 (9.2%) patientsdemonstrated more than moderate white matter. 

Pathways:A pathway (neuropsychology, neurology, geriatrics, or return to PC) was recommended for 287(71.4%) patients.  Pathways differed significantly across demographics and clinical features, (age, race/ethnicity, education, Medicaid, PHQ-9, GAD-7, functional status (FAST), preliminary functional diagnosis, pathway acceptance; all p≤0.05).Geriatrics:patientsmore often older and Hispanic, with worse FAST; Neurology:patients were more often Black, with higher acceptance (72.2%); Neuropsychology:higher PHQ-9 and lower acceptance; Return to PCP:more undetermined diagnoses.