Just one out of seven senior citizens takes part in assessments for cognitive problems, according to a new report from the Alzheimer’s Association. But much higher numbers get regular screenings for such ailments as heart disease, diabetes and cancer.
The disconnect means that millions of senior citizens with early cognitive problems aren’t getting medical attention early, when it can be most helpful, the report said.
Problems with cognition can have many causes, said Katie Croskrey, executive director of the association’s chapter for San Diego and Imperial counties in California. These include dehydration, stress, side effects of medication and poor blood circulation to the brain, Alzheimer’s or a mixture of causes. These issues can be detected early on with a variety of cognitive tests.
One of the most popular cognitive screens is the Montreal Cognitive Assessment. It’s usually given in person and takes about 15 minutes, said Ana Seda, the chapter’s director of programs. These include such tasks as drawing the hands of an analog clock, counting backward in a sequence and repeating sentences exactly as given.
If the assessment reveals a possible problem, a doctor will first check for issues not related to dementia, Croskrey said. If those causes are ruled out, at that point the patient would be sent to a neurologist for more sophisticated tests, such as a CT scan.
Alzheimer's the most common
While there are several causes of dementia, Alzheimer’s accounts for most cases. Both the number of Alzheimer’s patients and number of deaths from the disease are increasing.
In 2017, 16,238 Californians died of Alzheimer’s, a 268 percent increase over the number in 2000, the report stated. (In New York State, that number was 3,521 for the same year.) Nationwide, more than 5 million Americans now have Alzheimer’s, and by 2050 that number is projected to reach 14 million.
By contrast, deaths from heart disease and cancer from 2000 to 2017 have actually gone down, Croskrey said.
When it comes to physical maladies, 91 percent of senior citizens get their blood pressure measured; 66 get tested for diabetes; and 61 get cancer screenings. In addition, 83 percent get their cholesterol measured; 80 percent get vaccinations; and 73 percent get hearing or vision checked.
Just 16 percent of senior citizens get thinking and memory assessments, and even fewer get them regularly, according to the report.
Croskrey said one explanation is that people simply aren’t discussing their worries about thinking or memory loss with their physicians.
“The doctor probably won't do a memory test unless you share some concerns about your memory,” she said. That means people need to bring up the subject.
It’s normal to become more forgetful with aging, Croskrey said. Simply misplacing keys or other objects isn’t by itself a sign of dementia.
“If you find your keys in the refrigerator or you find them in other odd places where you cannot retrace your steps, then that's something you want to raise with your doctor,” Croskrey said.
Fear gets in the way
Fear is a major reason people don’t ask for cognitive screening, said Dr. Howard Feldman, director of the Alzheimer’s disease Cooperative Study at UC San Diego.
“It is really a dreaded event in a person's life,” Feldman said. “Physical ailments, bad as they are, leave you with mental intactness.”
In the worst case, dementia will take away a person’s “functional autonomy,” he said.
Overriding all is a stigma about having dementia.
Several factors make taking a cognitive test a wise idea for senior citizens, he said. One is that the patient may not have dementia at all, freeing that person from needless worry.
For those in the early stages of dementia, they have time to make important decisions, such as who will have power of attorney and look after their assets. Waiting puts people at risk of being defrauded.
Another is that certain health and lifestyle changes may reduce dementia’s toll, Feldman said. While the evidence for benefit isn’t proven, at the very least these changes won’t cause harm.
Early-stage patients whose cognitive impairment is mild may also be good candidates for taking experimental drugs that just might slow or stop the course of the disease.
And in the later stages, voluntarily giving up autonomy, such as ceasing to drive, could save someone else’s life, he said.
Those with questions about Alzheimer’s or other forms of cognitive impairment can get answers around the clock by calling the Alzheimer’s Association helpline at 800-272-3900. The association is online at alz.org.