Understanding the Underdiagnosis of Mild Cognitive Impairment in Older Adults

Understanding the Underdiagnosis of Mild Cognitive Impairment in Older Adults

Mild cognitive impairment, which is considered an early stage of dementia, is alarmingly underdiagnosed in individuals aged 65 and above, according to recent studies. These studies reveal that only a mere 8% of expected cases of mild cognitive impairment have been diagnosed, leaving approximately 7.4 million cases undiagnosed in the general population. Additionally, over 99% of primary care clinicians have been found to underdiagnose mild cognitive impairment in this demographic.

Mild cognitive impairment serves as an early warning sign for Alzheimer’s disease in around half of the cases and has a progression rate of 10% to 15% per year towards dementia. Recognizing and treating mild cognitive impairment in its early stages can potentially slow down disease progression and offer patients the opportunity to receive appropriate interventions. Addressable factors such as medication side effects, thyroid dysfunction, or vitamin B12 deficiency can sometimes cause mild cognitive impairment.

In 2023, the Food and Drug Administration approved lecanemab as the first disease-modifying treatment for Alzheimer’s disease, which is a common cause of mild cognitive impairment. Unlike previous drugs that only alleviate symptoms temporarily, lecanemab targets the root cause of the disease by reducing toxic amyloid plaques in the brain. Another drug, donanemab, is also expected to be approved in 2024. However, these treatments are most effective in the early stages of Alzheimer’s when patients are in the mild cognitive impairment phase.

Various barriers contribute to the underdiagnosis of mild cognitive impairment, such as subtle symptoms that mimic normal aging and the lack of awareness and understanding among healthcare providers. Physicians often dismiss memory concerns as a part of aging and may not prioritize cognitive assessments during routine visits due to time constraints. Additionally, cognitive tests to differentiate normal aging from pathological decline can be time-consuming and require follow-up appointments.

Individuals in their 60s and beyond, along with their families and friends, play a crucial role in recognizing and addressing cognitive decline. By proactively discussing cognitive concerns during doctor’s appointments and advocating for formal assessments, patients can increase the likelihood of early detection. The Medicare yearly “wellness” visit presents an opportunity to address cognitive health concerns, yet only half of beneficiaries take advantage of this service.

Just as physicians inquire about unexplained weight loss and take those concerns seriously, discussions about cognitive health should become a standard practice in healthcare settings. By raising awareness and prioritizing cognitive assessments, the rate of underdiagnosis of mild cognitive impairment can be reduced. Education and training for healthcare professionals, as well as public awareness campaigns, are essential in shifting towards a more proactive approach to cognitive health.

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