Most seniors with memory loss,
dementia skip free testing from Medicare
Free dementia clinical testing now available to all senior citizens in
Dec. 17, 2014 – Alzheimer’s disease and the associated loss of memory
and cognitive ability is
usually found to be the top fear of senior citizens. Yet, despite clear
evidence that memory and cognitive abilities are sliding down hill, the
majority of seniors with these symptoms have not been to a doctor for
University of Michigan researchers
and colleagues say their study suggests that as many as 1.8 million
Americans over the age of 70 with dementia are not evaluated for
cognitive symptoms by a medical provider, which in some patients,
lead to a failure to uncover modifiable causes of thinking or memory
published online in
Neurology, the medical journal of the American Academy
of Neurology, documents a clear lack of clinical testing for seniors
with signs of cognitive problems.
The study included people with mild
cognitive impairment through severe dementia, from all causes.
Those who were married, and those
with the worst levels of dementia symptoms, were more likely to have had
their memory and thinking ability evaluated by a primary care doctor,
neurologist or psychiatrist.
“Early evaluation and
identification of people with dementia may help them receive care
earlier,” says study author Vikas Kotagal, M.D., M.S., who sees patients
at the University of Michigan Health System and is an assistant
professor in the
U-M Medical School’s Department of Neurology.
“It can help families make plans
for care, help with day-to-day tasks including observed medication
administration, and watch for future problems that can occur. In some
instances, these interventions could substantially improve the person’s
quality of life.”
Signs of Dementia
● Being unable to remember
● Asking the same quiestion or
repeating the same story over and over.
● Becoming lost in familiar
● Getting disoriented about time,
people & places.
● Neglecting personal safety,
hygiene & nutrition.
Adapted from National Institute
Free dementia clinical testing now available to all seniors in Medicare
The data in the study come from
before the start of Medicare’s free annual wellness exams for seniors,
which began in 2011 under the Affordable Care Act and are required to
include a cognitive evaluation.
Even so, says Kotagal, “The results
of this study have implications in both primary care and specialty care
settings. Recognizing cognitive impairment in older individuals is
important, and physicians should explore reasons why dementia has
occurred and communicate these findings clearly with patients and family
members so that they can take this information with them when they leave
More about the study population
The study was part of a larger,
nationally representative, community-based study called the Health and
Retirement Study, based at the
U-M Institute for Social Research. From that study, 856 people age
70 and older were evaluated for dementia, including a video interview
and standard testing. For each participant, a spouse, child or other
person who knew the person well was asked whether the participant had
ever seen a doctor for any concerns about memory or thinking.
A total of 297 of the participants
met the criteria for dementia.
Of those, 45 percent had seen a
doctor about their memory problems – and the more severe their issues,
the more likely they had had that evaluation. By comparison, 5 percent
of those with memory and thinking problems that did not meet the
criteria for dementia had been tested by a doctor for those issues, and
1 percent of those with normal memory and thinking skills had undergone
People who were married were more
than twice as likely to undergo cognitive evaluations as people who were
not married. Why? “It’s possible that spouses feel more comfortable than
children raising concerns with their spouse or a health care provider,”
said Kotagal. “Another possibility could be that unmarried elderly
people may be more reluctant to share their concerns with their doctor
if they are worried about the impact it could have on their
Other demographic factors did not
have an effect on whether or not people had cognitive evaluations,
including race, socioeconomic status, the number of children and whether
children lived close to the parents. “Our results show that the number
and proximity of children is no substitute for having a spouse as a
caregiver when it comes to seeking medical care for memory problems for
a loved one,” Kotagal said.
Next stop: Finding out why
While the study doesn’t answer the
question of why people with signs of dementia don’t get tested, Kotagal
suggests that many factors may be involved - - some driven by the
patient, some by physicians, and others by the nature of our health
Many patients and physicians, he
says, may perceive that clinical cognitive exams don’t have enough
value. But experts have shown that they can improve medical outcomes and
help reduce societal costs.
For instance, knowing that a stroke
or vascular issues in the brain caused dementia means patients can work
to control risk factors like blood pressure that might otherwise cause
it to keep worsening.
The next steps in research on this
topic are to find out why patients don’t get tested, and what parts of
the diagnostic process are most valuable to patients and caregivers.
In addition to Kotagal, the study’s
authors include Kenneth Langa, M.D., Ph.D., who holds professorships in
both the U-M Medical School and Institute for Social Research; U-M
neurologist Roger Albin, M.D., U-M neuropsychologist Bruno Giordani,
Ph.D. and U-M researcher Mohamed Kabeto, M.S. Authors from other
institutions are Brenda Plassman, Ph.D. of Duke University, who directs
the ADAMS study from which the data on dementia patients was obtained;
and James Burke, M.D., Ph.D., Gwenith G. Fisher, PhD, Robert B. Wallace,
MD, MS, David C. Steffens, MD, MH and Norman L. Foster, MD. Langa is
a member of the U-M Institute for Healthcare Policy and Innovation.
The study was supported by the
University of Michigan, the National Institute on AgingWA, and
University of Utah.
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