Nearly everyone suffering from mild cognitive impairment (MCI) doesn’t receive a proper diagnosis, which can increase their chances of developing Alzheimer’s disease later in life.
Two recent studies found 92 percent of people experiencing MCI – a condition in which someone has mild problems with memory and decision-making – which can develop into dementia over time, are not being diagnosed at early stages, which could prevent people from accessing new treatments that may be able to delay cognitive decline if caught early enough.
In the first study, researchers used data from the Health and Retirement Study, a long-term survey of 20,000 people in the US, to build a model using a wide range of health and age factors that predicted the number of anticipated MCI diagnoses among people over 65 years old. The team determined 8million people would have the condition.
Then, they analyzed data from Medicare enrollees 65 and older in the program between 2015 to 2019 to determine how many people were actually diagnosed with MCI.
Comparing their data, they found MCI was missed in 92 percent of cases. Only eight percent of people whom their model predicted would develop MCI were actually diagnosed with the condition – indicating approximately 7.4million people were cognitively declining but unaware of it.
Ying Liu, a statistician at the University of Southern California and a researcher on both studies, said: ‘We knew it was bad, but we didn’t know it was that bad.’
The scientists also discovered the percentage of missed cases was even higher among Black and Hispanic enrollees.
The second study, also published by Liu and his team, examined Medicare claims from 226,756 primary care doctors with patients 65 and older and compared MCI diagnoses to their model.
Again, they found only eight percent of their predicted cases were actually diagnosed with MCI. Additionally, they found only 0.1 percent of doctors diagnosed the condition as often as the team calculated they should.
People with MCI have minor problems with their mental abilities, like memory and thinking. In these people, the difficulties are worse than what is normally expected for a healthy person of their age, but are not severe enough to be classified as dementia.
The Alzheimer’s Society estimates between five percent and 20 percent of people 65 and older live with MCI.
While it is not a type of dementia, people with MCI are more likely to develop dementia, including Alzheimer’s disease, later in life. However, if people are diagnosed with MCI early, they may be able to implement lifestyle changes to reduce their risk.
Dementia affects an estimated 7million people in the US, while approximately 5.8million Americans have Alzheimer’s disease.
And autopsies often reveal people who die in old age have some kind of impaired cognition, including amyloid plaques – a hallmark sign of Alzheimer’s disease.
While people who experience trouble remembering family members or who get lost can undergo cognitive testing, brain scans and blood work to diagnosis dementia or Alzheimer’s, diagnosing MCI is more difficult.
People may notice something is not right, but symptoms not be severe enough to cause alarm – and they most likely are still able to function independently. Because of this, many people experiencing MCI often only visit their primary care doctor, rather than memory care specialist clinics.
General practitioners may not see a lot of dementia patients or have experience with MCI, leading to a person’s condition to be missed.
A separate study reported a patient’s cognitive state was formally assessed in less than one-third of doctors visits. However, recent guidelines recommend a cognitive assessment be conducted at annual wellness check ups.
The researchers of the two recent studies said: ‘Increased efforts to detect MCI earlier are dearly needed, especially for socioeconomically disadvantaged groups, which have a higher risk of missed diagnosis.’
Previous research has shown older Black Americans are twice as likely to have Alzheimer’s disease or other dementias than older whites. Older Hispanics are about 1.5 times more likely to have the disease than their white counterparts due to confounding factors of comorbidities and social aspects, such as racism and discrimination.
Dr Keith Vossel, the Alzheimer’s Disease Program Director in the department of neurology at the University of California Los Angeles, previously told DailyMail.com education and communication are two major hurdles to overcome with the minority population and healthcare community when it comes to Alzheimer’s diagnosis and treatment.
While mistrust leads to a lack of communication, Dr Vossel said people in minority groups often ask why there are no doctors ‘that look like them’ that work with dementia patients.
He added: ‘Unfortunately there aren’t enough neurologists and dementia specialists from underrepresented groups. Doctors need to be able to identify with their community.’
In addition to a lack of minority doctors, there is also a lack of access to doctors and healthcare facilities in general.
Addressing the high rates of dementia in minority populations will require a multi-faceted approach and Dr Vossel said it will require everything from establishing a stable educational system that meets the needs of all its students, developing measures to combat heart disease and diabetes – comorbidities that may contribute to dementia – implementing dementia screenings at routine doctors visits and allowing for doctors to be reimbursed for those screenings.
There may be hope, however, for people developing dementia. An experimental Alzheimer’s drug developed by Eli Lilly slows cognitive decline by more than a third, the company announced in May.
In a Phase 3 trial, the drug, donanemab, slowed down the decline in patients’ ability to think clearly and perform daily tasks by 35 percent compared to a placebo.
Counties with highest prevalence of Alzheimer’s cases
Miami-Dade County, FL
Baltimore City, MD
Bronx County, NY
Prince George’s C., MD
Hinds County, MS
Orleans Parish, LA
Dougherty C. GA
Orangeburg County, SC
Imperial County, CA
El Paso, TX
Proportion (%), 2020
The data is for the proportion of the population aged 65 years and over