On March 5, the Alzheimer's Association released its annual Facts and Figures report, a compilation of the latest statistics on Alzheimer’s disease in the U.S. Besides summing up prevalence, mortality and morbidity, and costs of caregiving, the 70-page document features a special section highlighting the paucity of routine cognitive screening in primary care. While 80 to 90 percent of patients and primary care physicians voice support for regular memory tests, only half of physicians assess patients older than 65, which translates into 16 percent of seniors being routinely screened. The report examines the reasons behind the deficit and proposes ways to correct it.
- Most seniors and physicians agree that cognitive screening is important.
- Only one in six patients reports routine monitoring of his or her memory.
- The report highlights a gap between expectations and current numbers.
Regular cognitive assessments can indicate Alzheimer’s or other dementias early in the disease course. This can be helpful not just for life planning, but for enrolling in trials for potential treatments, for safety purposes, and to allow patients and families time to seek more information. Yearly cognitive checkups are covered by Medicare as part of the Annual Wellness Visit, a benefit included in the Affordable Care Act passed in 2010, but since then few have availed themselves of the provision. To find out why, the Alzheimer’s Association commissioned surveys for physicians and qualifying older adults.
About 1,950 patients and 1,000 physicians completed the surveys. At first, responses suggested that cognitive tests might be common. More than 90 percent of primary care physicians claimed it was important to examine patients for thinking and memory problems. Seniors agreed, with 82 percent saying their cognitive health should be monitored. However, these expectations belie what happens in practice. Only 47 percent of doctors reported routinely evaluating older patients for cognition, and just 16 percent of seniors report being tested during regular checkups. Routine screenings for other disorders such as cancer, diabetes, hypertension, and hypercholesterolemia received far greater attention (see image below).
Low Priority. Few seniors are assessed for memory or thinking (right). [Courtesy of Alzheimer’s Association.]
Why the gap? The surveys revealed a massive disconnect between doctors and patients as to whom they consider responsible for initiating the conversation about cognitive health. Most patients think doctors should suggest testing if they think it necessary, and only one in seven older adults broaches the topic first. However, many doctors initiate testing only if the patient, a family member, or a caregiver voices concern. Doctors also cite resistance from patients, or lack of time during a routine checkup, as reasons not to conduct regular tests. Two-thirds of patients don’t know the tests are covered by Medicare. Less than one-third of survey respondents knew about the annual wellness visit, and less than a fifth of beneficiaries had ever made use of it.
However, there are signs that doctors are ready to give cognitive screening more priority. Upward of 91 percent of those surveyed indicated that they would gladly accept more information about good tools to use and how to use them efficiently, as well as next steps to take when cognitive problems are found.
Other sections of Facts and Figures reported that the prevalence of Alzheimer’s ticked up this year, with an estimated 5.8 million people in the U.S. living with the disease, up from 5.7 million in 2018. That number is expected to nearly triple by 2050, and send costs of long-term, hospice, and nursing care from a current $290 billion to $1.1 trillion. The number of deaths from Alzheimer’s increased 145 percent from 2000 to 2017. According to the Centers for Disease Control and Prevention, 121,417 people died, though that number is likely an underestimate given that more acute conditions are often listed on death certificates.—Gwyneth Dickey Zakaib