Lennard L. van Wanrooij
Conservative estimates indicate that more than 100,000 U.S. Medicare recipients have undiagnosed dementia, according to published reports.
The Alzheimer’s Association has stated that that early and accurate diagnosis of dementia is “critical to the patient receiving high-quality care.”
Therefore, a tool that could help family physicians determine which older patients are at risk for dementia and need to be referred to a specialist would “be very helpful,” Lennard L. van Wanrooij, MSc, of the department of neurology at the University of Amsterdam, told Healio Primary Care.
A study by Van Wanrooij and colleagues, published in Annals of Family Medicine, describes a possible tool that could ascertain who is at risk for dementia.
After analyzing data from 3,454 community-dwelling individuals aged older than 70 years, van Wanrooij and colleagues found that subjective memory complaints — ascertained by asking the question, “Do you feel you have more problems with memory than most?” — when combined with results from the Mini-Mental State Examination and Visual Assessment Test, was helpful in predicting dementia.
A deeper dive into van Wanrooij and colleagues’ data showed the likelihood of future dementia was increased:
- with subjective memory complaints alone (HR = 3.01; 95% CI, 2.31-3.94);
- with imperfect Mini-Mental State Examination-5 score alone (HR = 2.14; 95% CI, 1.59-2.87); and
- with imperfect Visual Assessment Test score alone (HR = 3.19; 95% CI, 2.46-4.13).
Researchers reported that regarding the 14% of participants with subjective memory complaints at baseline, dementia occurred in 4% of those with optimal scores on the Mini-Mental State Examination and Visual Assessment Test and in 30% of those with imperfect scores on the Mini-Mental State Examination and Visual Assessment Test.
“These tests for older persons with subjective memory complaints can be very beneficial in primary care settings to estimate dementia risk in the elderly,” van Wanrooij said.
The findings were “not surprising” to Rebecca Edelmayer, PhD, the director of scientific engagement at the Alzheimer's Association. “We are learning more through research about the importance of subjective memory complaints in early detection of dementia,” she told Healio Primary Care.
She added that although van Wanrooij and colleagues used some of the “most commonly used assessments” to gauge cognitive decline, clinicians must remember that “there is no single diagnostic test that can determine if a person has Alzheimer's disease or any other type of dementia.”
Instead, diagnosing dementia is a multi-pronged approach. According to the Alzheimer’s Association, this means:
- obtaining the patient’s medical and family history, including history of cognitive and behavioral changes and psychiatric history;
- asking a family member to supply information regarding changes in the patient’s thinking skills and behavior;
- conducting cognitive tests and physical and neurologic examinations;
- performing blood tests and brain imaging to rule out other possible causes of dementia symptoms, such as certain vitamin deficiencies or a tumor; and
- utilizing brain imaging tools to ascertain the individual’s beta-amyloid levels.
“Early and accurate diagnoses are critical to ensure that people receive high-quality care and can plan for the future. It also enables enrollment in clinical trials at the earliest stages of disease when effective treatment may still be possible,” Edelmayer explained. – by Janel Miller
Alzheimer’s Association. 2019 Alzheimer’s disease Facts and Figures. https://www.alz.org/media/documents/alzheimers-facts-and-figures-2019-r.pdf. Accessed Oct. 22, 2019.
Koller D, Bynum JP. J Public Health (Oxf). 2015;doi:10.1093/pubmed/fdu080.
van Wanrooij LL, et al. Ann Fam Med. 2019;doi:10.1370/afm.2443.
Disclosures: van Wanrooji and Edelmeyer report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.