55% Of People with Dementia Have Never Been Screened
The majority of individuals with mild cognitive impairment or dementia have not discussed cognitive concerns with a medical provider in significant detail, according to a new study in Neurology.
Researchers found that 55% of study participants with dementia had never had their thinking and memory skills evaluated by a doctor.
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“These results suggest that approximately 1.8 million Americans over the age of 70 with dementia have never had an evaluation of their cognitive abilities,” says lead study author Vikas Kotagal, MD, MS, of the University of Michigan Health System in Ann Arbor. “Although our study doesn’t explore specific reasons for this trend, it is likely driven by many different factors involving patients, physicians, and other health system-based factors.”
Kotagal and his colleagues looked at data from the Aging, Demographics, and Memory Study (ADAMS), a nationally representative community-based cohort study of individuals ages 70 and above.
Of the 845 subjects in that study, 297 met criteria for dementia after a detailed in-person study examination. For each of these individuals, a spouse, child, or another person who knew the study subject well was asked whether the participant had ever seen a doctor for any concerns about memory or thinking.
Of these 297 participants, 45% had seen a doctor about their memory problems, compared to 5% of those with memory and thinking problems who did not meet the criteria for dementia, and 1% of those with normal memory and thinking skills.
“Many of the factors that we hypothesized would correlate with an increased likelihood for receiving a clinical cognitive evaluation in subjects with dementia showed no correlation in our multivariable analysis,” Kotagal says. That includes race, socioeconomic status, the number of children, and whether children lived close to their parents.
“After controlling for a number of potential confounders, being currently married and having more severe cognitive impairment were both associated with an increased likelihood of undergoing a community cognitive evaluation,” Kotagal says.
Being married had an especially significant impact—with married patients twice as likely to have a screening compared to those who were not married.
Kotagal and his colleagues would like to conduct further research in this area, specifically looking at the root causes behind these findings.
“Although this study shows that cognitive evaluations occur infrequently in patients with dementia, the next step is figuring out why. It is also critical to determine whether some elements of clinical cognitive evaluations are more ‘valuable’ to patients, physicians, or family members than others,” Kotagal says. “Answering this question by looking at longitudinal outcomes data would help provide more informed guidelines about how to work up age-related cognitive conditions.”
—Colleen Mullarkey
Reference
Kotagal V, Langa KM, Plassman BL, Fisher GG, Giordani BJ, Wallace RB, et al. Factors associated with cognitive evaluations in the United States. Neurology. 26 November 2014. [Epub ahead of print].