Screening for Cognitive Impairment

Contributed by: Dennis Fortier, President, Medical Care Corporation
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Yesterday, the U.S. Preventative Services Task Force (USPSTF) ruled that there is insufficient evidence to make a recommendation, either for or against, routine screening for cognitive impairment in older adults. Today, the press is ablaze with sloppy reporting on the matter.

Many news stories (like this from US News and World Report) are conflating cognitive impairment with dementia, but readers of this blog understand that cognitive impairment may be very mild whereas dementia is, by definition  a severe loss of cognitive capacity. Many others (like this from Time), are interchanging dementia and Alzheimer's disease, which inappropriately implies that the two are one in the same, and obscures the fact that Alzheimer's is but one of the many causes of dementia.

To be clear, the USPSTF did not rule against anything. They merely concluded that the evidence is not strong enough to make a recommendation one way or the other. More importantly, their ruling was related to "screening" of "older adults" for "cognitive impairment". In other words, should the healthcare system invest in regular cognitive assessment of all older adults, whether they suspect a problem or not? Their conclusion? They're not sure.  They're not for it and not against it.

Rather, the public should monitor their cognitive health vigilantly and promptly report concerns to their physicians for a thorough evaluation. This will allow early intervention against treatable problems like thyroid dysfunction, vitamin deficiency, anxiety/depression, sleep disorders, and out of control diabetes, all known contributors to cognitive deficits. It will also facilitate early diagnosis of Alzheimer's disease.

This is important because Alzheimer's can be effectively managed for a significant percentage of patients. Effective management of Alzheimer's includes early diagnosis, physical exercise, proper diet, strict control of hypertension and diabetes, poly-therapy with a cholinesterase inhibitor and Namenda, ongoing social and intellectual stimulation, and caregiver education. All of these interventions have been shown to promote optimal disease management and, when brought together as a robust therapeutic regimen, can be surprisingly effective.

The Global Cost of Dementia

Contributed by: Dennis Fortier, President, Medical Care Corporation
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With each new study, the numbers get bigger and scarier. The latest report, The Global Economic Impact of Dementia, released by the non-profit group Alzheimer's Disease International, is no exception. The full report can be downloaded here.

At a top line level, the report estimated the annual cost of care for demented patients at over $600B or about 1% of the world's gross domestic product. Astoundingly, that figure is dwarfed by the projected rise in costs over the next decades. In fact, the report estimates that costs could reach nearly $2 trillion by the year 2050. A good summary of these findings are published online by Time.

While a cure is the goal that everyone seeks, a cold economic look at the disease makes it clear that the crippling expense of care comes primarily from patients in the moderate to severely demented stages of illness, when they cannot administer their own lives. While delaying progression to those stages might seem to be an uninspiring health care goal, it is a very attractive economic goal.

To that end, earlier intervention and robust treatment, including a balanced diet, physical exercise, pharmaceutical therapy, and tight control of diabetes and any present cardiovascular risks, should be a high priority in the primary care setting.

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A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share button below to spread this educational message as widely as possible.