Rural Americans Face Higher Alzheimer’s Risk and Lack Access to Early Diagnosis, New Report Warns

WASHINGTON—Rural Americans face a significantly higher risk of Alzheimer’s yet lack access to the diagnostic tools needed to detect the disease early, leaving many patients unable to access treatment, according to a new report from the Information Technology and Innovation Foundation (ITIF), the leading think tank for science and technology policy. Rural Americans will continue to be left behind unless policymakers expand access to tools and resources that allow earlier, more accessible Alzheimer’s diagnosis outside major medical centers.

More than 6 million Americans are living with Alzheimer’s disease, a number projected to approach 14 million by 2060. While early diagnosis has become increasingly important as emerging Alzheimer’s treatments are most effective in the earliest stages of the disease, rural residents carry a disproportionate share of risk. They are 11 percent more likely to have hypertension, 22 percent more likely to be obese, and 29 percent more likely to have diabetes than urban residents—all conditions that increase the risk of Alzheimer’s and related dementias. Further, nearly 60 percent of rural adults age 65 and older live in areas with limited access to neurologists and memory care specialists, delaying diagnosis and limiting access to treatment.

“Rural Americans face a double disadvantage when it comes to Alzheimer’s disease,” said Sandra Barbosu, associate director of ITIF’s Center for Life Sciences Innovation. “They are more likely to have conditions that increase dementia risk, and they are far less likely to have access to the specialists and diagnostic tools needed for early detection. Expanding access through scalable technologies will be critical to closing this rural health gap.”

The report analyzes how elevated health risks and limited diagnostic infrastructure combine to worsen Alzheimer’s in rural America. It examines the prevalence of modifiable dementia risk factors, the availability of neurologists and memory care specialists, and the emerging technologies that could expand early detection outside major medical centers. The findings show that new diagnostic tools, including blood-based biomarker tests and digital cognitive screening technologies, could significantly expand early Alzheimer’s diagnosis in rural communities. However, Medicare does not cover blood tests as screening tools for Alzheimer’s disease, which are now emerging for use in people with Alzheimer’s disease biomarkers but who are not yet cognitively impaired. While cognitive assessments furnished by a clinician as part of the Annual Wellness Visit are generally covered by Medicare, coverage of fully remote, stand-alone digital screenings remains limited and inconsistent.

Fully realizing the benefits of these tools will require leaders to address the barriers that prevent them from reaching rural communities.

To overcome this growing challenge, policymakers should:

• Create a pathway for Medicare coverage of FDA-cleared blood tests for Alzheimer’s screening
• Introduce a new CPT code for digital cognitive assessments, which would create ideal conditions for providers to use these tools to identify individuals with early symptoms of Alzheimer’s disease
• Support training programs that help primary care providers identify cognitive decline earlier
• Strengthen federal support for rural hospitals and clinics adopting new diagnostic technologies.

By expanding coverage for new Alzheimer’s screening tool, more patients can be screened in primary care settings rather than requiring referrals to distant specialists. Workforce training and rural health investments will simultaneously help ensure providers can detect Alzheimer’s earlier and connect patients to treatment before the disease progresses.

“The science and technology needed to expand Alzheimer’s screening and diagnosis already exist,” said Barbosu. “The challenge now is ensuring rural patients can access them. Expanding coverage for new screening tests, strengthening the rural health workforce, and supporting clinics adopting these technologies will ensure Alzheimer’s patients in rural America are not excluded from the next generation of treatments.”

Contact: Austin Slater, [email protected]