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Many People with Dementia May Go Unscreened, Untreated
The majority of people with dementia in the United States may have never seen a doctor about their memory and thinking problems, according to a new study of older adults.
The researchers found that 55 percent of patients screened for dementia as part of the University of Michigan Health and Retirement Study had never been evaluated prior to participating in this study, despite showing a clear cognitive decline.
Although the study was small — it included 845 people — the results imply that upwards of 1.8 million Americans ages 70 and older with dementia also have either never been screened, or are not receiving treatment.
This is a lost opportunity because intervention could substantially improve some people's quality of life, the researchers wrote in their study, published today (Nov. 26) in the journal Neurology. [10 Ways to Keep Your Mind Sharp]
"Early evaluation and identification of people with dementia may help them receive care earlier" and help reduce societal costs, said Dr. Vikas Kotagal, lead author on the paper and assistant professor of neurology at the University of Michigan Health System in Ann Arbor.
People with dementia may have any of a host of brain conditions that cause long-term difficulties in thinking and reasoning that are severe enough to affect daily life. The most common form is Alzheimer's disease.
Most forms of dementia have no cure, and treatment is limited. Nevertheless, screening for dementia at its earliest stages might help doctors slow the progression or better equip family members and the patient to deal with the disease, Kotagal said.
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Some forms of dementia stem from poor nutrition and can be reversed. One common, reversible cause of dementia is vitamin B12 deficiency.
"There are [several] factors that commonly contribute to overall cognitive disability in patients with dementia that can get better with medical management, namely depression and sleep disorders," Kotagal told LiveScience. "Many dementias are caused by cardiovascular risk factors. Identifying these risk factors and modifying them in at-risk individuals can lead to a change in the natural [progression] of these conditions."
For non-reversible forms of dementia, some studies have shown that exercise, social interactions, and engaging the mind in puzzles and games may help slow the progression, although to a very limited degree. Medications, too, such as cholinesterase inhibitors, may have a small but positive effect in helping patients maintaining longer bouts of clear thinking.
The new study also found that people who were married were more than twice as likely to have had dementia screening as people who were not married.
"It's possible that spouses feel more comfortable than children [do] raising concerns," about dementia, 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, he added.
Deciding when to see a doctor can be tricky, the researchers wrote, given that tests are not standardized and most seniors experience at least some cognitive decline that's not dementia.
The U.S. Preventive Services Task Force, a non-governmental panel of health experts, does not recommend universal screening for dementia because the benefits of pharmacological treatment might not outweigh the risks.
"Performing this testing in clinically symptomatic older individuals, however, is a different story," Kotagal added. For people with symptoms, a screening may be a great help.
People with a family member who needs more help with tasks that they have always been able to handle — specifically because of thinking and memory problems — should consider scheduling a visit to discuss this with the person's doctor, he said.
The symptoms of dementia usually first appear after age 60, and the risk increases with age. By age 85, between 25 and 50 percent of people exhibit signs of Alzheimer’s disease, according to the Centers for Disease Control and Prevention.
Under the Affordable Care Act, Medicare now reimburses people for Annual Wellness Visits that can include an assessment of cognitive function.
Follow Christopher Wanjek @wanjek for daily tweets on health and science with a humorous edge. Wanjek is the author of "Food at Work" and "Bad Medicine." His column, Bad Medicine, appears regularly on Live Science.
Christopher Wanjek is a Live Science contributor and a health and science writer. He is the author of three science books: Spacefarers (2020), Food at Work (2005) and Bad Medicine (2003). His "Food at Work" book and project, concerning workers' health, safety and productivity, was commissioned by the U.N.'s International Labor Organization. For Live Science, Christopher covers public health, nutrition and biology, and he has written extensively for The Washington Post and Sky & Telescope among others, as well as for the NASA Goddard Space Flight Center, where he was a senior writer. Christopher holds a Master of Health degree from Harvard School of Public Health and a degree in journalism from Temple University.