More Seniors May Have Undiagnosed Dementia Than Previously Thought

Summary: Nine out of ten older adults who reported symptoms of cognitive decline associated with dementia did not have a clinical diagnosis of neurodegeneration.

Source: University of Michigan

Only 1 in 10 older adults in a large national survey who were found to have cognitive impairment consistent with dementia reported a formal medical diagnosis of the condition.

Using data from the Health and Retirement Study to develop a nationally representative sample of roughly 6 million Americans age 65 or older, researchers at the University of Michigan, North Dakota State University and Ohio University found that 91% of people with cognitive impairment consistent with dementia told questioners they had a formal medical diagnosis of Alzheimer’s disease or dementia.

“(The discrepancy) was higher than I was expecting,” said Sheria Robinson-Lane, study co-author and assistant professor at the U-M School of Nursing.

When proxy reporters (generally, family members) responded, the prevalence dropped from 91% to around 75%, which is still very significant, she said. While many people may have been diagnosed and remain unaware or forgot about their diagnosis, what’s concerning is that cognitive assessment, specifically dementia screening, isn’t routine during annual well visits for older adults.

COVID-19 gives these numbers heightened significance because people with dementia have higher risk for hospitalization and death following an infection, Robinson-Lane said. COVID-19 also causes long-standing neurological effects in some people, perhaps increasing risk for future dementia-related diagnoses.

“Now more than ever, these routine screenings and assessments are really critical,” she said. “I think it’s particularly important to have some baseline information available to providers of patients over 65.”

Co-author Ryan McGrath, an assistant professor at North Dakota State University, suggested that the migration to telemedicine during the COVID-19 pandemic further underscores the importance of cognitive assessments.

“We recommend that health care providers screen for low cognitive functioning during routine health assessments when possible,” he said. “A telemedicine option may reduce clinic time and expand reach.”

The prevalence of not having reported a dementia-related diagnosis, despite being identified as living with a cognitive impairment consistent with dementia, differed by gender, education and race.

People who identified as non-Hispanic Black had a higher estimated prevalence (93%) of no reported diagnosis, as did males (99.7%) compared to females (90.2%) The estimated prevalence of no reported diagnosis for non-high school graduates was about 93.5%, compared to 91% for those with at least a high school education.

“There is a large disparity in dementia-related treatment and diagnosis among Black older adults, who are often diagnosed much later in the disease trajectory compared to other racial and ethnic groups,” Robinson-Lane said.

This shows an older man and clocks
The prevalence of not having reported a dementia-related diagnosis, despite being identified as living with a cognitive impairment consistent with dementia, differed by gender, education and race. Image is in the public domain

Education is often a proxy for socioeconomic status, so throughout life, wealthier individuals have more access to resources that affect both risk and disease progression, she said. And, evidence suggests that education may influence cognitive testing performance.

The Medicare visit is supposed to include a cognitive screening, but it can be difficult to ascertain a cognitive concern in a 20-minute annual visit, she said. Adding a specific cognitive assessment can also take up visit time.

Often, Robinson-Lane hears from concerned family members who don’t know next steps, or the family member they’re concerned about wants to maintain independence and privacy, and doctors can’t share information without the patient’s consent.

She encourages open communication and reminds families that they can still share information with the loved one’s provider directly or through a nurse or medical assistant.

About this dementia research news

Source: University of Michigan
Contact: Laura Bailey – University of Michigan
Image: The image is in the public domain

Original Research: The findings will appear in Journal of Alzheimer’s Disease

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  1. Hi,
    I agree that that screening for dementia should be part of annual check and actually should be addresses as a separate visit because in 20 minutes the doctor doesn’t have enough time to get past the “hello!”. My partner went to many doctors for other issues and nobody listen to him more attentively when they asked what medication you take for example, and he answered ,he can’t remember. Nobody asked him why? It was not the spelling of the medication but the fact that he did not had that memory that he was taking some of the things prescribed. And more intriguing, nobody suspected he had dementia till was in advanced stage. None of the doctors had the curiosity to ask what is his daily routine, to find out that he was very sedentary, not interested in reading or being social and so on. The food he was interested in, was the same everyday, no interest in trying anything new, so he probably lack a lot of nutrients. When he had to go take the written test at the DMV it took him 3 tries to make it, and again nobody suspected (the clerks at the testing ) Now his license is suspended of course but I overheard at one of my recent visits at the DMV 2 older ladies were chatting about the same issue, and then I was thinking to myself they will be driving in the streets and nobody knows if they have any slight chance of dementia and they probably should not be driving. Doctors should craft a better interview at the visits and not believe all that the patient is sharing because some of the truth is hiding behind human pride and memory loss. The person close to the patient should be interviewed on some daily facts on a separate visit or over the phone when the patient is not present. I stayed through an interview and most his answers were very far from what really was going on his daily bases, but I think the doctor believed most what he was answering. Now my partner is in a nursing home and I feel that is good for him that he is getting some medical help that he needed so much. This disease is terrible for anybody to go through. Hopefully my comment will help someone or pave the way for better visits after a certain age.

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