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Disconnect between seniors, physicians on cognitive assessments: Report

Submitted by the Alzheimer’s Association

Findings from the Alzheimer's Association 2019 Alzheimer's Disease Facts and Figures report released March 5 show that, despite a strong belief among seniors and primary care physicians that brief cognitive assessments are important, only half of seniors are being assessed for thinking and memory issues, and much fewer receive routine assessments.

In addition to providing an in-depth look at the latest statistics on Alzheimer's prevalence, incidence, mortality, costs of care and impact on caregivers nationally and in Wisconsin, the new Facts and Figures report examines awareness, attitudes and utilization of brief cognitive assessments among seniors age 65 and older and primary care physicians.

A brief cognitive assessment is a short evaluation for cognitive impairment performed by a health care provider that can take several forms — including asking a patient about cognitive concerns, directly observing a patient's interactions, seeking input from family and friends or using short verbal or written tests that can be administered easily in the clinical setting. An evaluation of cognitive function is a required component of the Medicare Annual Wellness Visit, but findings from the report show that only 1 in 3 seniors are aware these visits should include this assessment.

The report also found, however, that among both seniors and primary care physicians there is widespread understanding of the benefits of early detection of cognitive decline and the importance of brief cognitive assessments. In fact, 82 percent of seniors believe it is important to have their thinking and memory checked, and nearly all primary care physicians (94 percent) consider it important to assess all patients age 65 and older for cognitive impairment.

"There is a rise in the financial and emotional impact that Alzheimer's has on families caring for their loved one. For patients 65 or older, we urge you to be proactive with your primary care physician to seek a cognitive assessment. Early detection of cognitive impairment offers numerous medical, social, emotional and planning benefits for both affected individuals and their families," said Laurie Schill, executive director of the Alzheimer's Association, Greater Wisconsin chapter.

The report found that just 16 percent of seniors say they receive regular cognitive assessments for memory or thinking issues during routine health checkups, compared with blood pressure (91 percent), cholesterol (83 percent), vaccinations (80 percent), hearing or vision (73 percent), diabetes (66 percent) and cancer (61 percent).

The Facts and Figures report also reveals a troubling disconnect between seniors and primary care physicians regarding who they believe is responsible for initiating these assessments and reticence from seniors in discussing their concerns.

The survey found that while half of all seniors (51 percent) are aware of changes in their cognitive abilities — including changes in their ability to think, understand or remember — only 40 percent have ever discussed these concerns with a health care provider, and fewer than 15 percent report having ever brought up cognitive concerns on their own. Instead, most seniors (93 percent) say they trust their doctor to recommend testing for thinking or memory problems if needed. Yet fewer than half of primary care physicians (47 percent) say it is their standard protocol to assess all patients age 65 and older for cognitive impairment. Only 26 percent report having a physician ever ask them if they have any concerns about their cognitive function without seniors bringing it up first.

"It's normal to feel nervous about undergoing a cognitive assessment, but there are steps you can take to have a productive conversation with your doctor and to understand what to expect from an assessment," Schill said.

Nearly all physicians said the decision to assess patients for cognitive impairment is driven, in part, by reports of symptoms or requests from patients, family members and caregivers. Physicians who choose not to assess cognition cite lack of symptoms or complaints from a patient (68 percent), lack of time during a patient visit (58 percent) and patient resistance (57 percent) as primary factors.

In addition, most physicians say they welcome more information about assessments, including which tools to use (96 percent), guidance on next steps when cognitive problems are indicated (94 percent) and steps for implementing assessments efficiently into practice (91 percent).

"The Alzheimer's Association is working to support PCPs on best practices for conducting cognitive assessments. We are here to provide information and resources regarding patient assessment, diagnosis and care planning. You can reach us directly at 920-469-2110," Schill said.

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