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The Risks of Not Screening Older Adults for Alzheimer’s and Other Forms of Dementia

PCPs fail to recognize between 27 and 81% of cases of a patient displaying signs of cognitive impairment. Early detection can make treatment more effective.

Adults over 65 face many health risks, so screening this population for each condition associated with aging can be challenging, especially when you only get 15 minutes with a patient once or twice a year.

As a result, research shows primary care providers fail to recognize between 27 and 81% of cases of a patient displaying signs of cognitive impairment. This stat is harrowing for many reasons, not the least of which is that the sooner dementia is detected, the more effective treatment will be.

Screen Adults 65 and Older for Dementia Once a Year

To encourage more early diagnoses, for the first time, the American Academy of Neurology (AAN) is recommending all providers who provide neurological treatment screen every patient 65 and older for cognitive impairment once a year. The complete quality improvement assessment was published in Neurology.

It’s a big step that Marie Carmel Garcon, DNP, FNP, professor at Columbia Nursing School, who specializes in gerontology, fervently agrees with. Dr. Garcon stresses that screening is crucial to protect patients from other risks of the condition — such as falling, malnutrition, financial and physical abuse, isolation, and failure to adhere to treatment plans for other chronic diseases.

“With Alzheimer’s and dementia comes so much,” she adds.

That said, Dr. Garcon recognizes the time constraints providers are up against, especially when an older patient already suffers from hypertension, diabetes, or high cholesterol. “Of course, then you’re focused on that,” she says.

How To Screen for Alzheimer’s and Dementia

Luckily, there are many screeners available that take only a few minutes. Dr. Garcon prefers the Self-Administered Gerocognitive Examination (SAGE) because it is “fast and reliable.” It takes about four minutes, and patients can complete it independently or with assistance.

She also advocates for the better-known Mini-Mental State Exam, which can take up to seven minutes. If that’s too long, the Mini-Cog needs only three. And last, there’s the five-question Brief Alzheimer’s Screen, which is easy to score.

Even if a dementia screening isn’t on your agenda for a specific patient, Dr. Garcon says to watch for a few indicators you should add in. In her experience, sudden changes in appearance, for example, if a patient suddenly appears disheveled, is a sign. Also, look for forgetfulness, confusion of place and time, appetite loss, paranoia, and personality changes.

Dr. Garcon adds that screenings are most successful if you’ve built a relationship with your patient. That’s why it’s ideal for PCPs to perform them. When asking questions or talking with patients about their responses, “don’t accuse them or try to argue,” Dr. Garcon advises. “Ask them what they think, give them time to explain, and show empathy.”

Referring Patients to a Specialist

If you’ve screened a patient a couple of years in a row and have noticed a decline, then involve a neurologist, Dr. Garcon says. Seeing any of the four As of Alzheimer’s — amnesia, apraxia, aphasia, and agnosia — is another sign specialized care might be needed.

Because dementia is such a complicated condition, many providers assume only specialists should deal with it, but that’s a disservice to patients. As Dr. Garcon explains, “Primary care providers are in the best position to intervene early on. You’re the first one who’s going to see the changes.”

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