Unseen and Unscreened: Structural Inequities in Cognitive Screening Uptake Among Older Adults in the U.S.

Background: Age related cognitive decline is a key concern in the USA and its early diagnosis using cognitive screening remains underutilized in preventive care for older adults. This brief report explores disparities in cognitive screening uptake among older adults in the U.S and provides actionable policy to address gaps in screening uptake. Methods: Using 2023 survey data from the National Poll on Healthy Aging dataset (N = 1,293), we examined the prevalence of cognitive screening among U.S. adults aged 65–80 and identified social and structural determinants influencing screening patterns. Logistic regression was employed to determine predictors of screening. Results: Nearly 58% of older adults reported never having undergone cognitive screening. Screening rates were lowest among adults aged 65–69 and highest among those aged 75–80. Educational attainment strongly predicted screening uptake, with college-educated individuals 68% more likely to be screened. Lack of a primary care provider was associated with a 56% lower likelihood of screening. Notably, higher income did not confer increased screening likelihood. Cognitive screening appeared more reactive—triggered by memory complaints—than integrated into routine preventive care. Conclusion: Substantial disparities in cognitive screening exist along educational and structural lines, undermining its role as a preventive tool. Strategies such as leveraging community health workers, promoting telehealth tools, and embedding cognitive testing in routine visits may help close these gaps and promote equity in brain health.