The gap in diagnosis of dementia is bigger than we thought

I still remember seeing my grandfather’s postal notes in my house. He would write things like “avoid elevators, climb stairs” and “do math”. My grandfather had long determined that his cognitive decline was an effective way for clinicians to seize it early and do their best to slow progress. As a family of professionals in the healthcare industry, we still strive to provide him with the screening and treatment he needs.

This was decades ago, and unfortunately, despite many major breakthroughs in the field, there is still a lot of room for improvement in dementia testing. In the United States, there are more than 60 million adults over the age of 65, and the study found that more than 60% of older people who may have dementia do not know they have it. As part of my work on screening for dementia, I interacted with health care providers. Many have admitted that they have patients with diagnostic criteria for mild cognitive impairment or dementia, but they have stopped doing so for a variety of reasons.

Today, some doctors have similar dementia to cancer observations decades ago. Cancer once discussed in a silent tone and was frustrated to diagnose. Unfortunately, treatment options have been improved due to recent significant efforts to cut cancer research, and doctors can offer patients a clear next step that could lead to cures.

There is no clarity and confidence in Alzheimer's and other dementias. There are new drugs available, but they are not perfect. There are profound findings about the impact of lifestyle changes, but many clinicians don’t know how to talk to them. There are exciting new plans to support people with Alzheimer's disease and their families, but it has not been widely used yet. Doctors don’t have the resources or bandwidth to help you browse this follow-up care, so they are reluctant to add official stamps to the diagnosis.

This needs to be changed. The loss of Alzheimer's disease is $360 billion a year, and as the population grows, the disease needs to become a public health priority. As more patients are screened and diagnosed, we learn more about the disease to inform clinical trials and drug developments. This stimulates new treatments and ultimately allows doctors to provide more effective options for improving patient outcomes. This is what you need to make it a reality.

Empowering patients

Every adult over 65 years of age should undergo cognitive impairment screening. In fact, the 2011 requirement of the Medicare & Medicaid Service Center (CMS) was a requirement such as measuring blood pressure or cholesterol. When I mention this to my friends who belong to the baby boomers, they often learn about it in surprise and prompt them to see their providers. The problem is that many providers do not comply or have to tick the box at least, and patients don’t know they can ask for screening. Making cognitive screening a routine part of these dates for patients aged 65 and older normalizes the idea of ​​checking brain health every year and gives older people the ability to raise concerns about early symptoms when they appear.

Equipped with primary health care providers

Primary care providers (PCPs) are on the frontline of dementia diagnosis, but many don’t have the right tools or enough time to lead this fee. We need to provide providers with simplified objective assessment tools to integrate into existing workflows. The new technology has the ability to evaluate concisely, giving PCP more time to discuss the next step with patients. The technology should prioritize nursing program support to guide primary care practitioners in a timely, appropriate and personalized next step to help patients and caregivers to support patients at each stage. In addition to technology, continuing education should include the latest guide to recognizing early signs of cognitive impairment, having conversations with patients and families, and connecting them to follow-up care.

Emphasize early intervention

One of the biggest headlines in 2023 is ignoring how obvious mild cognitive impairment (MCI) is (USC analysis found that 99% of PCP diagnosis is less than 99%). Although most subsets of individuals with MCI continue to develop into Alzheimer's disease or other dementia, in some cases, the damage is due to other sometimes seeking causes (e.g., sleep apnea, infection, major depression, over-medication). Either way, MCI is a major red flag and an important call for action. Medicare's V28 changes help shift attention to the mild phase of dementia. I hope this trend will continue, taking care and focusing on snacks as we find more ways to stop or slow progress.

The diagnosis of dementia is complicated. Trust me, I know. After dealing with my grandparents’ condition, I was navigating the ripple effect of the dementia diagnosis with another close family member. We need to authorize our aging population to seek screening, providers to receive diagnostics and regulatory agencies to promote awareness and simplify reimbursement. With dementia cases expected to double in the United States by 2060, it is time to close the gap.

Image: Radachynskyi, Getty Images

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