February 11, 2013
It’s no secret that the incidence of Alzheimer’s disease and other dementias among older adults is growing exponentially worldwide. What remains unspoken, however, are formal diagnoses for millions of those dementia cases. An estimated 50 to 80 percent of the individuals living with dementia in high-income countries have not received a diagnosis, according to the World Alzheimer Report 2011 (PDF 1.8MB), preventing the affected individuals from receiving appropriate treatment and support.
Benefits of an Early Diagnosis
The 2011 World Alzheimer’s Report listed the following benefits of an early diagnosis for people with dementia and those that care for them:
- Optimizing current medical management,
- Relief gained from better understanding,
- Maximizing decision-making autonomy while still retaining mental capacity,
- Access to services that require the patient to have a diagnosis,
- Risk reduction,
- Planning for the future,
- Improving clinical outcomes – slowing or stabilizing cognitive and functional decline, and
- Avoiding or reducing future costs – chiefly through delaying or avoiding need for care outside of home.
Steps for Promoting an Earlier Diagnosis
1. Practitioner and Patient Education
If you’re a health practitioner reading this article, you have likely already gained some awareness of the unmet need for dementia diagnosis and the benefits of an earlier diagnosis, which are important motivations to address this issue. Training interventions for professionals such as practice-based workshops have also proven to increase identified cases of dementia, according to the results of a UK study reviewed in the 2011 World Alzheimer’s Report.
Older patients need to understand that dementia is not a normal part of aging and should be encouraged to report symptoms to their primary care doctors or request an assessment. The Alzheimer’s Association (U.S), The Alzheimer's Society (Canada) and Help For Alzheimer’s Families are three helpful resources for patient and family education—both pre- and post-diagnosis.
2. Screening at the Primary Care Level
According to the World Alzheimer Report 2011, evidence from high income countries “suggests that primary care physicians and nurses can, if specifically prompted to do so, make a dementia diagnosis with reasonable accuracy, using their knowledge of the patient, available case note information, and their own routine assessments, in the limited time available during a typical consultation.” Given the short consultation times, experts suggest using the General Practitioner Assessment of Cognition (CPCOG), the Memory Impairment Screen (MIS) and the MiniCog, which can be administered in five minutes or less with reasonable validity.
3. Effective Coordination with Specialists
Primary care services play an important role in the initial diagnosis and specialist referral. Improving communication and coordination between primary care physicians and specialists such as neurologists or geriatricians can ensure the right diagnosis is made with an appropriate treatment plan to follow.
While increased detection of dementia is an attainable goal with many benefits, it has limited value unless the diagnoses are “sensitively shared with those directly affected, accompanied by support, timely intervention and access to continuing care,” the 2011 World Alzheimer’s Report noted.
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