December 31, 2014
More than half of people with Alzheimer’s disease or other forms of dementia have never seen a doctor about their memory and thinking problems, a new study reports. The findings suggest that many people with Alzheimer’s, particularly those in the earlier stages of the illness, may be missing out on care and planning that can improve quality of life.
“Approximately 1.8 million Americans over the age of 70 with dementia have never had an evaluation of their cognitive abilities,” said study author Dr. Vikas Kotagal of the University of Michigan Health System in Ann Arbor. “Yet early evaluation and identification of people with dementia may help them receive care earlier.”
The study, published in the medical journal Neurology, from the American Academy of Neurology, looked at 845 men and women over 70 who were part of the Aging, Demographics, and Memory Study, a nationally representative sample of older Americans. All were given thinking and memory tests, and 297 were diagnosed with Alzheimer’s or another form of dementia.
For each study participant, a spouse, child or other person who knew the person well was asked whether the participant had ever seen a doctor for any concerns about memory or thinking. Among the almost 300 people with dementia, only 45 percent had seen a doctor about their memory problems. Remarkably, only 5 percent of those with serious memory and thinking problems — though not dementia — had been evaluated. Only 1 percent of those with normal memory and thinking skills had been screened for dementia.
The researchers found that people who were married were more than twice as likely to have been tested as people who were not married. “It’s possible that spouses feel more comfortable than children raising concerns with their spouse or a health care provider,” Dr. Kotagal said. “Another possibility could be that unmarried elderly people may be more reluctant to share their concerns with their doctor if they are worried about the impact it could have on their independence.”
Not surprisingly, people with more severe memory and thinking problems were also more likely to have been evaluated by a doctor than those with milder impairments.
More than one in eight Americans over age 65 has Alzheimer’s or another form of dementia, the authors note, and most have not been screened for their disease. Medical groups generally do not recommend routine dementia screening for healthy seniors. Routine screening can lead to false positive results, in which someone is incorrectly diagnosed with dementia, leading to unnecessary anxiety.
But those with memory problems can benefit from testing, because early diagnosis may allow for earlier care and better planning that can improve quality of life.
The findings are consistent with earlier research showing that Alzheimer’s remains under-recognized among elderly individuals, even among those who regularly visit a doctor. Under the Affordable Care Act, Medicare coverage, the insurance program for seniors, now includes an annual wellness visit that allows for screening to assess cognition. If someone is having memory problems, it may be a good idea to get a medical evaluation.
Source: Vikas Kotagel, MD, MS; Kenneth M. Langa, MD, PhD; Brenda L. Plassman, PhD, et al: “Factors Associated With Cognitive Evaluations in the United States.” Neurology, Vol. 84, pages 1-8, 2015.