Millions of people over the age of 65 are likely to have mild cognitive impairment (MCI), a condition in which they have mild problems with memory and decision-making that can progress to dementia over time. . However, two recent studies both show that 92 percent of people experiencing MCI in the United States are not diagnosed early, and new evidence suggests that early detection may slow cognitive decline. It concludes that no cure for Alzheimer’s disease is available.
“We knew it was bad. But we didn’t know that that That’s bad,” said Ying Liu, a statistician at the University of Southern California’s Center for Economic and Social Research and a researcher on both studies.
Originally published this summer Alzheimer’s disease research and treatment, Liu’s team aimed to understand how often MCI is diagnosed, and how often it is overlooked. Using data from Research on health and retirementThrough a longitudinal study of approximately 20,000 people in the United States on a wide range of age-related factors, Dr. Liu developed a model that predicts approximately 8 million MCI diagnoses across the population aged 65 and older. Did. Next, Liu’s team extracted data from all Medicare beneficiaries aged 65 and older who enrolled from 2015 to 2019 to see how many had actually been diagnosed with the disease. They found that of the people their model predicted to be candidates for MCI based on health demographics, only 8 percent actually received a diagnosis. The numbers were even lower for black and Hispanic beneficiaries and low-income households. (The research team used eligibility for Medicaid, a health insurance supplement to Medicare, as a measure of income status.)
a second studyA paper published in October by Liu’s team looked at Medicare claims filed by 226,756 primary care physicians and compared their MCI detection rates to those predicted by the model. Once again, they found that only about 8 percent of predicted cases were actually diagnosed, and only 0.1 percent of clinicians diagnosed the condition at the frequency the team calculated.
Autopsies have revealed that most people who die at an older age have some form of brain pathology that impairs cognitive function, from traces of stroke to amyloid plaques, a hallmark of Alzheimer’s disease. Brian James, an epidemiologist at Rush Alzheimer’s Disease Center, said that while not everyone with anatomical markers of neurodegeneration will experience memory loss, “the more of these in the brain, the more likely you are to develop dementia.” There is a higher chance of developing the disease.” He was not involved in this study. People who experience problems such as forgetting who family members are or getting lost while walking on familiar paths may be treated with a combination of cognitive tests, brain scans, blood tests, and spinal taps. It may be possible to identify the cause of dementia.
Mild cognitive impairment is much more difficult to diagnose. People may notice that something is wrong, but are still able to function independently. Most are seen by primary care physicians rather than researchers at memory care clinics. Because these doctors see fewer patients with dementia, they may have less confidence in making a potentially life-changing diagnosis for a patient. “They don’t want to make mistakes,” says Sarah Klemen, a neurologist at the Jonah Goldrich Alzheimer’s Disease and Memory Disorders Center, who was not involved in the study.
“As medical professionals, we still struggle with how to best identify mild cognitive impairment,” added primary care physician Barak Gaster, who is also a professor at the University of Washington School of Medicine. Many doctors in Gaster’s field recognize that they lack training in dealing with cognitive issues and are eager to learn. However, annual Medicare health visits are time-sensitive and often only take 15 minutes. cover a lot of ground. Cognitive assessments are too broad to detect the subtleties of MCI. “It’s very difficult to ask local health care providers to do something different because they’re already doing it. all” said Nancy Berlinger, a senior fellow at the Hastings Center, an independent bioethics institute in New York. Additionally, people generally don’t want to be told they have memory problems. “Primary care providers may avoid the topic because of the stigma surrounding dementia,” Dr. Berlinger says.
