Should Primary Care Physicians Provide Dementia Screening? Too Many Patients Go Undiagnosed

Article excerpt

Alzheimer's disease affects more than 5 million Americans and is the fourth-leading cause of death in the United States. Yet by many accounts, only 50% of the cases are diagnosed, and only 25% of patients receive the medication they need. In 40 years, more than 15 million Americans may have the disease.

This serious illness remains underdiagnosed because primary care physicians do not routinely screen patients for dementia. Early symptoms are subtle, and many patients appear normal in the context of a routine office visit. Even close friends and family members may not fully appreciate the significance of early changes in memory and behavior. Before anyone senses the growing problem, the patient may have difficulty managing medications for comorbid illness, may fail to report important symptoms, and may have an increased risk of auto accidents, poor financial judgment, and financial victimization.

Clearly, the way we identify these patients is inadequate, and this inadequacy will be magnified as the number of Alzheimer's disease patients grows. Primary care screening is one way to ensure that more patients get the help they need at the time it can benefit them most--early in the disease process.

Neither the U.S. Preventive Services Task Force nor the Alzheimer's Association endorses routine memory screening for elderly Americans. But such a program could have enormous benefits for our patients. Although approved medications do not alter disease course, they can improve the quality of life for both patients and their families by boosting cognitive performance for a limited period of time. Data suggest that the cholinesterase inhibitors are most beneficial when administered early.

Disease-modifying agents aimed at slowing neurodegeneration are likely to become available within 5-10 years. These will certainly be most beneficial to patients in the earliest stages of Alzheimer's disease. Early detection through screening will be crucial to their success.

Early identification also puts families in the best position to plan for their loved one's care by making decisions about transportation, living arrangements, finances, and other social and legal matters while the patient is still functioning at a relatively high level. …