Researchers weighed the positives and negatives of testing older adults for cognitive impairment at the primary care level.
Early detection of dementia and Alzheimer’s disease can help patients get the care and help they need sooner rather than later, but there is currently no standard in place to screen people at the primary care level. Now, researchers say that screening for dementia in primary care could be helpful, and new study results show that it wouldn’t be harmful to patients, either.
In a new study out of Regenstrief Institute and Indiana University (IU) School of Medicine, researchers conducted a randomized controlled trial on dementia screening, hoping to weigh the positives and negatives of testing older adults for cognitive impairment at the primary care level.
No harm done by screening
When someone begins exhibiting symptoms of dementia, a family member or loved one may bring them to the doctor to get a memory test. Often, however, people who are at risk of developing dementia — or who are already experiencing the disease — don’t get screened for dementia early on.
There has also been some concern that screening every older adult who walks into primary care for cognitive impairment could cause anxiety — especially if the patient doesn’t want to know whether they have dementia, or are at a high risk of developing it.
The study examined dementia screenings in rural, suburban and urban primary care clinics throughout Indiana. The main finding of the report was that primary care dementia screening didn’t increase anxiety or depression among the people studied — and the researchers concluded they found no harm in screening for Alzheimer’s and other types of dementia.
“Dementia screening provides awareness for the patient and their family, allowing them to take action — including advance care planning — and we now know that the screening does not harm the patient,” Nicole Fowler, associate director of the Indiana University (IU) Center for Aging Research at Regenstrief Institute, said in a news release. Fowler is also an assistant professor of medicine at IU School of Medicine.
“Many patients and families have concerns that dementia screenings may create anxiety or depression in patients because there is, as yet, no cure for this disease,” Fowler continued. “However, this study shows that is not the case.”
However, screening didn’t necessarily improve the rate of people following up for a diagnosis or care. 70 percent of the participants declined follow-up assessments. Among those who did follow up assessments, though, there was a decrease in hospital admissions compared to people who weren’t screened and later developed cognitive impairment.
“For a number of reasons, including the lack of drugs to treat dementia and the stigma around the condition, people are hesitant to engage in the next steps of the process after screening,” Fowler said. “The health care system needs to help bridge this gap and encourage people to follow up on the results of screening tests as they would for any other condition.”
Importance of early detection for dementia
Doctors argue that early detection is crucial in helping patients get the care they need, and in some cases even help slow down progression of the disease through lifestyle changes and treatment.
“We diagnose Alzheimer’s Disease too late,” Dr. Stephen Rao at Cleveland Clinic’s Lou Ruvo Center for Brain Health told Being Patient in a past interview. “For most people, the disease is probably going on for ten, 15 years before they’re diagnosed.”
“You get a physical exam at the doctor, they’ll measure your weight and blood pressure,” Rao continued. “But when you see your primary care physician — even though the Medicare annual wellness visits for people over 65 is supposed to involve some form of cognition testing — most doctors don’t have time [to complete memory tests].”
Some efforts have been underway to increase early detection, though it’s still not standard practice in primary care check-ups. Researchers have been examining the use of retinal scans to identify Alzheimer’s in early eye exams; beta-amyloid protein can appear in retinal tissue in advance of memory decline. Recently, researchers launched a $5 million study to boost detection efforts with retinal imaging.
Yes, I plan to ask my primary care doctor on my next visit since my sister has dementia and my mother died with Alzheimer’s.