A new study finds that more than half of people over the age of 70 with signs of dementia haven’t seen a doctor about it.
Researchers from the University of Michigan say their findings suggest that as many as 1.8 million Americans over the age of 70 with dementia have not been evaluated by a physician.
“Early evaluation and identification of people with dementia may help them receive care earlier,” said 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 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.”
The data in the study was collected before the start of Medicare’s free annual wellness exams for seniors, which began in 2011 under the Affordable Care Act, the researchers noted. A cognitive evaluation is required as part of those free exams.
The study was part of the larger Health and Retirement Study, based at the university’s Institute for Social Research.
From that study, 856 people age 70 and older were evaluated for dementia, including a video interview and standard testing. The researcher also asked a spouse, child, or friend of each participant if the participant had ever seen a doctor for any concerns about memory or thinking.
According to the researchers, 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, five 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 one percent of those with normal memory and thinking skills had undergone testing, the study found.
The researchers also found that people who were married were more than twice as likely to undergo cognitive evaluations as people who were not married.
“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 independence.”
Other demographic factors did not have an effect on whether people had cognitive evaluations, including race, socioeconomic status, the number of children, and whether children lived close to the parents, according to the researchers.
“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.
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 the nation’s health system.
“Many patients and physicians may believe that clinical cognitive exams don’t have enough value,” he said.
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 will be more likely to control risk factors like blood pressure, Kotagal noted.
“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,” he concluded.
The study was published in Neurology, the medical journal of the American Academy of Neurology.