Panel urges better detection of dementia
Too few people with signs of mental decline or dementia are getting checked during routine medical visits or told when a problem is found, says a panel of Alzheimer’s disease experts who offered new guidance Sunday.
The idea is to get help sooner for people whose minds are slipping — even if there’s no cure. Though mental decline can be an uncomfortable topic for patients and their doctors, the panel says family physicians should do a thorough evaluation when concerning symptoms arise and share the diagnosis candidly.
Patients and family members should push for an evaluation if they’re worried that symptoms might not be normal aging — the difference between occasionally misplacing keys versus putting them in the freezer or being confused about their function.
“By the time you forget what the keys are for, you’re too far gone to participate in your own care. We’ve lost probably a decade” that could have been spent planning, said the panel’s leader, Dr. Alireza Atri, a neurologist at Banner Sun Health Research Institute in Arizona.
It’s not just memory that can suffer when mental decline starts, Atri said.
“It’s actually people’s judgment being off, their character and personality being off,” sometimes years before dementia is diagnosed, he said.
About 50 million people worldwide have dementia; Alzheimer’s is the most common form. In the United States, nearly 6 million have Alzheimer’s and almost 12 million have mild cognitive impairment, a frequent precursor.
In 2015, Alzheimer’s Association research using Medicare records suggested that only about half of people who were being treated for Alzheimer’s had been told by their health care provider that they had been diagnosed with the disease.
“All too often, physicians will hear of some symptoms or memory complaints from patients or their spouse and say, ‘you know, you seem OK to me today,’” so check back in six months, said James Hendrix, an Alzheimer’s Association science specialist who worked with the panel. Meantime, the patient may end up hospitalized for problems such as forgetting to take a diabetes medicine because their mental impairment wasn’t caught.
“We hear stories all the time of people taking years to get an accurate diagnosis,” said Nina Silverberg, a psychologist who runs Alzheimer’s programs at the National Institute on Aging, which had no role in the guidelines.
Medicare recently started covering mental assessments as part of the annual wellness visit, but doctors aren’t required to do it and there was no guidance on how to do it, she said. In some cases, it might be as cursory as asking “how’s your memory?”
The panel was appointed by the Alzheimer’s Association and included primary care doctors, aging specialists, nurses and a psychiatrist. Broad guidelines were released on Sunday at the group’s international conference in Chicago; details will be published later this year. The guidelines do not recommend screening everyone. They outline what health workers should do if people describe worrisome symptoms. That includes: checking for risk factors that may contribute to dementia or other brain diseases, including family history, heart disease and head injuries; pen-andpencil memory tests; imaging tests to detect small strokes or brain injuries that could be causing memory problems.