Less Than Half of Seniors With Dementia Get Cognitive Testing
A cohort study finds that the lack of preventive mental health screenings is not limited to healthy seniors or those with mild impairments.
Many older people experience so-called “senior moments,” and the occurrence and expectance of such memory lapses—or possibly the fear that they might signal oncoming dementia—may contribute to an individual’s reluctance to have his or her memory and cognition tested.
But while screening delays might be expected among healthy seniors or those with mild memory issues, a study published in Neurology has found that the underuse of clinical cognitive evaluations (CCEs) extends even deeper.
An analysis of 845 seniors (aged 70 and up) found that 55 percent of those with clear symptoms of cognitive decline reported no history of a CCE. The participants were part of a nationally representative community study called ADAMS (Aging, Demographics, and Memory Study).
If these data were extrapolated to the general U.S. population, it suggests that nearly 2 million seniors with clinical dementia have not seen a physician about their memory problems.
Key Points
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Among 297 seniors (aged 70 and above) identified with clinical dementia, 55 percent had not received a cognitive evaluation from a physician.
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Of various demographic factors tested, marriage was the only one associated with a greater likelihood of receiving an evaluation.
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Among seniors with mild cognitive impairment, only 5 percent had previously received an evaluation.
Bottom Line: A majority of seniors are not being screened for potential dementia, even when they show clear symptoms. This poses a serious public health concern for an aging U.S. population.
“This reluctance to get screened is a serious public health issue,” said lead study author Vikas Kotagal, M.D., an assistant professor of neurology at the University of Michigan. “Unfortunately, there is no simple answer to explain why.”
Kotagal noted that many factors come into play, some from the patient, some from physicians, and some from the nature of health care.
To get more insight into the patient perspective, Kotagal and his colleagues looked at different demographic factors to see whether any particular category of seniors was more likely to get screened. Age, race, gender, and net worth did not influence likelihood of having a CCE, nor did the number or proximity of children. The only group that was more likely to get their memory evaluated was married people.
“Now, it’s very encouraging that marriage was a positive reinforcement,” Kotagal said, “but I don’t think telling more people to get married is a solution. Rather, we should look at all those demographic elements that had no effect and realize this is a broad problem that cuts across the whole senior community.”
In addition to the 45 percent evaluation rate among subjects with full dementia, this work also found that only 5 percent of seniors with cognitive impairment, but not clinical dementia, had received a mental evaluation from a physician, while just 1 percent of seniors with normal memory had undergone cognitive testing.
Kotagal noted that recent changes under the Affordable Care Act to include free wellness exams as part of Medicare might improve this situation, but he also pointed out that the cognitive evaluation is only one component of 40 screening items that need to fit in the limited time that many patients can spend with their primary care doctor.
“So we have to make sure that both physicians and patients treat cognitive wellness as a priority in these exams,” he said.
To accomplish that, fear will be a big issue to overcome, noted David Steffens, M.D., chair of the Department of Psychiatry at the University of Connecticut Health Center.
“Older adults have likely seen many prominent people diagnosed with Alzheimer’s or experienced the gradual cognitive decline in their own family members, and they’re probably aware of the lack of effective treatments, and it gives them pause,” Steffens told Psychiatric News.
There is also the great fear of losing autonomy and independence and fear that the senior may not be trusted to carry out tasks like caring for grandchildren, for example.
There’s also debate about whether CCEs are worthwhile, as there is no solid evidence yet that routine mental screening improves long-term health outcomes, whereas the risks of false positive diagnoses are quite real.
Steffens, who is a coauthor of this study, believes that early detection of dementia is still important for several reasons. “Yes, Alzheimer’s has no cure, but we have interventions that can slow down the illness. Early intervention also can help families adjust and make appropriate plans such as getting all legal measures in order and arranging care.”
Kotagal and his team plan to follow up on the topic of screening importance as well by surveying why seniors, their families, and their physicians find CCEs to be of limited value.
This study was funded by a grant from the National Institute on Aging, with additional support from the University of Michigan and University of Utah Center for Alzheimer’s Care, Imaging, and Research. ■
An abstract of “Factors Associated With Cognitive Evaluations in the United States” can be accessed here.
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Published online: 31 December 2014
Published in print: December 20, 2014 – January 2, 2015
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