The challenge to diagnose and treat cognitive decline in our growing aging population is great. Alzheimer’s diagnosis in the US is predicted to soar (to 13.8 million in 2060, up from 6.2 million in 2021)—and so are nationwide shortages of specialists, including geriatricians and neurologists.
This one-two punch puts pressure on primary care physicians (PCPs), often the first ones patients share their cognitive concerns with, to efficiently perform cognitive screenings on patients 65 and older.
While there is no cure for dementia, reliable, early detection is vital because behavioral and lifestyle interventions can slow cognitive decline, reduce dementia risk, and improve quality of life. Additionally, all current FDA-approved medications for Alzheimer’s dementia are designed to slow progression in those with mild cognitive impairment (MCI) and early Alzheimer’s, making early detection crucial for the use of disease-modifying treatments (DMT).
Unfortunately, though, only about half of older adults report receiving any assessment for cognitive issues, and only about a quarter of Medicaid Advantage or fee-for-service Medicare beneficiaries get a structured cognitive assessment at their annual wellness visit (even though detection of cognitive impairment has been a required component of that visit since 2011).
Nearly all PCPs surveyed in an Alzheimer’s 2023 Facts & Figures report feel it’s important to diagnose MCI for patients 60 and over. But, they concede, they face several roadblocks to providing this service. The following are the most common barriers for PCPs to providing accurate and vital cognitive assessments to older patients:
1) Using traditional screening methods
While there are currently a variety of cognitive assessment testing methods available, such as the Montreal Cognitive Assessment (MoCA), the Mini-Mental State Exam (MMSE), and the Saint Louis University Mental Status Exam (SLUMS), they are time-consuming to administer—taking up to 15 minutes or more to complete. Furthermore, scoring can be subjective, and test results are subject to human error, depending on the administrator.
2) Waiting until the patient or their family member expresses concern about cognitive symptoms
Nearly all PCPs report waiting for patients (97%) or family members (98%) to make them aware of symptoms or request an assessment. With biomarkers for Alzheimer’s present in the brain up to 20 years before outward signs of decline, early screening and annual monitoring could dramatically change health outcomes. The rate of undetected dementia in the United States is about 61%, and detection rates for MCI are even lower.
3) Referring patients to a specialist for assessment
With most PCPs reporting that they are not comfortable or do not have the skill set to diagnose MCI, they are referring their patients to specialists for help. Unfortunately, there is currently a shortage of specialists. Therefore, when referred out, patients are often sent into a “neuro desert,” having to wait months for an appointment or consultation, losing precious time to implement lifestyle changes, start DMT, or enroll in a clinical trial.
To avoid these bottlenecks, PCPs and their staff will need to handle more of the diagnosis and care for patients. But how do they proceed with their current time restraints and lack of confidence in the testing options at their disposal?
A reliable, objective, cognitive test that is quick and simple to use is critically needed to address the growing need for screening that fits into the workflow of a yearly checkup. Neurotrack’s 3-Minute Cognitive Screening enables providers to identify cognitive impairment, an early indicator of neurodegenerative diseases such as Alzheimer’s, during their annual wellness visit.
This digital tool quickly and objectively delivers test results to healthcare providers with better accuracy than traditional methods and uses culturally-agnostic symbols and numbers to reduce bias in testing for those with other languages, backgrounds, and cultures.