Earlier dementia detection urged by experts panel
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Too few people with signs of dementia are getting checked during routine medical visits or told when a problem is found, says a panel of Alzheimer鈥檚 disease experts. The idea is to get help for people whose minds are slipping鈥 even if there鈥檚 no cure.
Though mental decline can be an uncomfortable topic for patients and their doctors, the panel says family physicians should do a thorough evaluation when concerning symptoms arise and share the diagnosis.
Patients and family members should push for an evaluation if they鈥檙e worried that symptoms might not be normal aging鈥 the difference between occasionally misplacing keys versus putting them in the freezer or being confused about their function.
鈥淏y the time you forget what the keys are for, you鈥檙e too far gone to participate in your own care. We鈥檝e lost probably a decade that could have been spent planning,鈥 said the panel鈥檚 leader Dr Alireza Atri, a neurologist at Banner Sun Health Research Institute in Arizona.
鈥淚t鈥檚 not just memory that can suffer when mental decline starts. It鈥檚 actually people鈥檚 judgment being off, their character and personality being off, sometimes years before dementia is diagnosed.鈥
About 50 million people worldwide have dementia. Alzheimer鈥檚 is the most common form. In the United States, nearly 6 million have Alzheimer鈥檚 and almost 12 million have mild cognitive impairment, a frequent precursor.
In 2015, the Alzheimer鈥檚 Association research, using Medicare records, suggested only half of the people who were being treated for Alzheimer鈥檚 had been told by their healthcare provider that they had been diagnosed with the disease.
鈥淎ll too often, physicians will hear of some symptoms or memory complaints from patients or their spouse and say, 鈥榶ou know, you seem OK to me today,鈥 so check back in six months,鈥 said James Hendrix, an Alzheimer鈥檚 Association science specialist who worked with the panel. Meantime, the patient may end up hospitalized for problems such as forgetting to take a diabetes medicine because their mental impairment wasn鈥檛 caught.
鈥淲e hear stories all the time of people taking years to get an accurate diagnosis,鈥 said Nina Silverberg, a psychologist who runs Alzheimer鈥檚 programs at the National Institute on Aging. Medicare recently started covering mental assessments as part of the annual wellness visit, but doctors aren鈥檛 required to do it and there was no guidance on it, she said. In some cases, it might be as cursory as asking 鈥渉ow鈥檚 your memory?鈥
The panel was appointed by the Alzheimer鈥檚 Association and included primary care doctors, aging specialists, nurses and a psychiatrist. Broad guidelines were released last Sunday at the group鈥檚 international conference in Chicago and details will be published later this year.
The guidelines do not recommend screening everyone. They outline what health workers should do if people describe worrisome symptoms. That includes: checking for risk factors that may contribute to dementia or other brain diseases, including family history, heart disease and head injuries; pen-and-pencil memory tests; imaging tests to detect small strokes or brain injuries that could be causing memory problems.
A diagnosis should never be withheld out of fear of making the patient depressed. At her daughter鈥檚 urging, Anne Hunt visited her family doctor in 2011 because of increasing forgetfulness. Hunt, 81, recalls struggling with memory tests involving letters and numbers that her doctor had her perform. 鈥淚 thought, 鈥極K, this is it. I鈥檓 a vegetable,鈥欌 Hunt said. But the test results were inconclusive and there was no diagnosis.
鈥淲e didn鈥檛 do much about it,鈥 said Bruce Hunt, Anne鈥檚 husband, until five years later, when her behavior deteriorated.
She was diagnosed with Alzheimer鈥檚 after an imaging test showed brain changes often seen with the disease. Imaging tests are sometimes used along with mental tests to diagnose the disease or rule out other conditions.
鈥淭here鈥檚 no pill they can take to make it go away, so some people think there鈥檚 no point to getting a diagnosis, but that鈥檚 not true,鈥 the National Institute of Aging鈥檚 Silverberg said. 鈥淚t really does offer an opportunity to plan.鈥
Alzheimer鈥檚 medicines such as Aricept and Namenda can ease symptoms but aren鈥檛 a cure. Experts say other benefits include a chance to join experiments testing treatments, resolve finances, find caregivers, make homes safer and use memory aids and calendars to promote independent living.
The Hunts joined support groups and a singing ensemble, hoping that trying new things would help them both cope. They were better prepared than some. Long before her diagnosis, they converted a vintage Chicago apartment building into two spacious homes so they could 鈥渁ge in place鈥 with help from one of their daughters and her family. Anne Hunt said she had wanted to know the truth about her diagnosis.
鈥淣ot to know is to wonder why things are happening to you and you don鈥檛 understand them,鈥 she said. 鈥淚 would rather know and have somebody help me figure out how can I control this to the best of my ability.鈥
(AP)
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