The researchers found that 55 percent of patients screened for dementia
as part of the University of Michigan Health and Retirement Study had
never been evaluated prior to participating in this study, despite
showing a clear cognitive decline.
Although the study was small — it included 845 people — the results
imply that upwards of 1.8 million Americans ages 70 and older with
dementia also have either never been screened, or are not receiving
treatment.
This is a lost opportunity because intervention could substantially
improve some people's quality of life, the researchers wrote in their
study, published today (Nov. 26) in the journal Neurology. [10 Ways to Keep Your Mind Sharp]
"Early evaluation and identification of people with dementia may help
them receive care earlier" and help reduce societal costs, said Dr.
Vikas Kotagal, lead author on the paper and assistant professor of
neurology at the University of Michigan Health System in Ann Arbor.
People with dementia may have any of a host of brain conditions that
cause long-term difficulties in thinking and reasoning that are severe
enough to affect daily life. The most common form is Alzheimer's disease.
Most forms of dementia have no cure, and treatment is limited.
Nevertheless, screening for dementia at its earliest stages might help
doctors slow the progression or better equip family members and the
patient to deal with the disease, Kotagal said.
Some forms of dementia stem from poor nutrition and can be reversed.
One common, reversible cause of dementia is vitamin B12 deficiency.
"There are [several] factors that commonly contribute to overall
cognitive disability in patients with dementia that can get better with
medical management, namely depression and sleep disorders," Kotagal told
LiveScience. "Many dementias are caused by cardiovascular risk factors.
Identifying these risk factors and modifying them in at-risk
individuals can lead to a change in the natural [progression] of these
conditions."
For non-reversible forms of dementia, some studies have shown that
exercise, social interactions, and engaging the mind in puzzles and
games may help slow the progression, although to a very limited degree.
Medications, too, such as cholinesterase inhibitors, may have a small
but positive effect in helping patients maintaining longer bouts of
clear thinking.
The new study also found that people who were married were more than
twice as likely to have had dementia screening as people who were not
married.
"It's possible that spouses feel more comfortable than children [do]
raising concerns," about dementia, Kotagal said. Another possibility
could be that unmarried elderly people may be more reluctant to share
their concerns with their doctor if they are worried about the impact it
could have on their independence, he added.
Deciding when to see a doctor can be tricky, the researchers wrote,
given that tests are not standardized and most seniors experience at
least some cognitive decline that's not dementia.
The U.S. Preventive Services Task Force, a non-governmental panel of
health experts, does not recommend universal screening for dementia
because the benefits of pharmacological treatment might not outweigh the
risks.
"Performing this testing in clinically symptomatic older individuals,
however, is a different story," Kotagal added. For people with symptoms,
a screening may be a great help.
People with a family member who needs more help with tasks that they
have always been able to handle — specifically because of thinking and
memory problems — should consider scheduling a visit to discuss this
with the person's doctor, he said.
The symptoms of dementia
usually first appear after age 60, and the risk increases with age. By
age 85, between 25 and 50 percent of people exhibit signs of Alzheimer’s
disease, according to the Centers for Disease Control and Prevention.
Under the Affordable Care Act, Medicare now reimburses people for
Annual Wellness Visits that can include an assessment of cognitive
function.
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