Dementia Screening: Part 2 of 2

Contributed by: Dennis Fortier, President, Medical Care Corporation
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Earlier today, I made the case that the recommendations from the Alzheimer's Society might be inadequate.  They have advocated for dementia screening in persons over age 75, which is a step in the right direction.  But as I wrote in Part I of this post, the dementia stage is too late; we need earlier intervention.

I posted those thoughts after reading about the new recommendations, in this BBC article, which includes a second discussion that I think should be explored.  It is the discussion about how to interact with patients who prefer not to know about their cognitive health.  Unfortunately, the dogma of the 1990's, when it may have been better "not to know", still persists a decade later, when we are sure that early intervention against all causes of cognitive decline is beneficial.

While that concern about interactions with unwilling patients cannot be dismissed, I would like to offer a constructive perspective on how to think about cognitive assessment in medical practice.  When a patient has a concern about their memory or other cognitive functions, and they visit a doctor to express those concerns, they have already declared their "wish to know".  Those who would prefer ignorance do not seek their doctor's advice and care.

Certainly, physicians should not submit their patients to unwanted tests about concerns that their patients choose not to address.  In that regard, automatic testing at a certain age, would carry some complications.  But I don't think that is what anyone is suggesting.  We merely need to arm physicians with the proper tools and the appropriate guidelines, so that when memory concerns are raised, they know how to intervene most beneficially.

Dementia Screening: Part I of 2

Contributed by: Dennis Fortier, President, Medical Care Corporation
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I like to support clear steps in the right direction, but I have mixed feelings about the Alzheimer's Society recommending that physicians screen their patients for dementia beginning at age 75.

Granted, it is difficult for even the greatest physicians to address additional health concerns, outside of those that brought the patient to the clinic, during a typical visit.  The structured nature of most health care interactions simply does not allow enough time for such exploratory activity.  Since few patients visit a physician about a memory or cognition concern, until the problem is severe,  most early stage problems are never addressed in primary care.

This leads to very late detection of cognitive problems and poor treatment outcomes based on late intervention.  From that perspective, the Alzheimer's Society has taken a laudable approach to improving care.

However, my problem with their recommendation is that it hinges on the term dementia, which refers to a state of such severe impairment, that a patient is no longer able to care for themselves without human assistance.  Even the term "early dementia" means that the threshold of severity has been crossed, and the patient's cognition is so poor that it has hampered their ability to function in daily activities.  For most patients, and most causes of dementia, this is likely to be too late for meaningful intervention.

To improve care and keep our aging population cognitively intact, we need to detect more subtle symptoms so as to treat the underlying causes before a person becomes demented.  This is the only way to preserve "high quality of life" and to contain the exorbitant costs associated with caring for demented populations. 

Excellent tools for evaluating cognitive health and for detecting subtle signs of decline are available to primary care physicians.  Contrary to the statement in the BBC article to which this post is linked,  these assessments take only a few minutes and fit soundly within the logistics of a primary care practice.

I applaud all efforts to encourage the evaluation of memory and cognitive function in the physician's office, but I emphasize that these efforts must focus on detecting problems early enough to treat them effectively.

Lack of Education About Alzheimer's Disease

Contributed by: Dennis Fortier, President, Medical Care Corporation
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The Alzheimer's Society in the UK recently published the results of their survey exploring the degree to which the average person understands this disease.

While there was no surprise that the average citizen is not aware of recent scientific advances, certain findings were somewhat alarming. In that regard, the fact that a third of respondents thought Alzheimer's disease was an inevitable part of normal aging was particularly illuminating.

Additionally, about a quarter of all respondents were not aware that risk factors can be managed to reduce the likelihood of dementia. Given this low level of understanding, one can easily see why there is not a greater proactive approach by aging patients to engage their physicians in discussions about memory loss.

In the near term, the greatest health care advance we can facilitate in the Alzheimer's field will be driven by education. If we had a well-informed public visiting enlightened physicians where cognitive health was regularly and objectively monitored, we would identify memory disorders much earlier and intervene with greater clinical success.

More Encouraging News about Dementia Education

Contributed by: Dennis Fortier, President, Medical Care Corporation
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As I noted here last week, an educational campaign sponsored by the Alzheimer's Society seemed to be sensitizing the public to the importance of seeking medical attention to discuss memory concerns. This comment was based on a survey of people in the UK who reported that their likelihood of seeing a physician about a memory concern was increased after seeing the advertising campaign.

In news today, physicians have reported an actual increase in the number of patients coming to them with suspicion of a memory disorder. This provides encouraging further evidence that the campaign will have a meaningful impact on the health of the UK's aging population.

As earlier facts presented in this blog make clear, educating the public and catalyzing earlier intervention against memory impairing medical conditions looks to be one of the most effective strategies in combating the growing prevalence of dementia. I hope we can all support and implement a similar approach in the USA.

Encouraging news about Dementia Education

Contributed by: Dennis Fortier, President, Medical Care Corporation
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One of the major challenges in the fight against memory disorders is the general lack of understanding about the importance of early intervention. While we have all come to accept the importance of a timely diagnosis in the case of cancer and other progressive diseases, we have not, as a society, made that connection to Alzheimer's disease.

I am very encouraged to read today about a campaign funded by the Alzheimer's Society in the UK that has reportedly been quite successful in this regard. Apparently, the educational campaign (Titled: Worried About Your Memory?) has increased the likelihood that a person with a memory concern will discuss their situation with a physician. This is an important step that we need to encourage in the USA as well.