Yesterday we commented on the common misdiagnosis of Lewy Body Disease, a problem often mistaken for Alzheimer's Disease. In keeping with that theme, we look today at results from an international physician survey on Alzheimer's diagnoses.
Based on a survey of nearly a thousand physicians in five countries (USA, Japan, UK, France, and Italy), we are not doing a very good job at diagnosing Alzheimer's disease in clinical practice. In fact, about half of all physicians agreed that the disease is "often misdiagnosed" and that diagnoses are "always or often" made too late to treat in a meaningful way.
None of this is news to regular readers of this blog as late detection of cognitive impairment is one of our frequent themes. However, the survey revealed an interesting perspective from the physicians, in terms of "why" they feel diagnoses are so commonly late.
According to the physicians surveyed, the major contributing factors to late diagnosis are:
- lack of a definitive diagnostic test;
- lack of communication from patients/caregivers; and
- stigma
Not mentioned among their reasons is the one glaring problem that primary care physicians confess to me on a regular basis. I hear frequently from physicians that investigating memory complaints takes too much time, and often leads to a diagnosis of a problem they don't feel they can treat effectively. This perspective often leads them to "just keep an eye on the concern" until symptoms worsen and the need for medical intervention is clear. As the survey noted, this is "too late".
Managing the cognitive health of an aging population is a complex problem, and a difficult one to approach within the confines of our current "fee for service" healthcare system. As new models evolve, like the Accountable Care Organizations described in the Healthcare Reform Act, we will have an opportunity to greatly improve our standards of care in this important field.
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