Who Reaches Specialty Dementia Care? Characterizing Geographic, Demographic, and Referral-Pathway Disparities in Rural America

Purpose: Although there is growing evidence showing rural–urban disparities in dementia risk, diagnosis, and outcomes, little is known about the unique structural barriers faced by rural older adults to access specialty dementia care. Identifying patterns in key health disparities, such as travel distance, gaps in referral pathways, and sociodemographic differences, is essential for understanding modifiable system-level inequities. This study characterized such factors among older adults presenting for dementia evaluation at a single academic medical center serving a highly rural U.S. state. Methods: This retrospective chart review study included 751 patients (age=72.3, education=14.1, %White=84.8, %Female=59.8) evaluated for dementia within the University of Arkansas for Medical Sciences Neuropsychology Program. We characterized the impact of travel distance, rurality, referral source, and demographic factors on care access, and examined factors associated with the odds of receiving a cognitive diagnosis. Findings: Travel distance to the clinic was substantial (>10% drove >100 miles) and rural residents were systematically underrepresented (ps<.001). Community-based referral, rural residence, and having a non-White racial/ethnic identity were all associated with greater odds of receiving a cognitive diagnosis (ps=.002-.025). Conclusions: Substantial travel burden and referral patterns shape access to specialty dementia care in this rural population. Older adults receiving care in community settings may experience delayed diagnosis, underscoring the need for rural provider education, telehealth consultation, and strengthened referral pathways. Evidence for the disparities affecting rural and ethnic/racial minoritized older adults highlights the need for culturally responsive outreach to promote brain health equity in rural settings.