The impact of dementia and how cognitive testing can make a difference

Currently, more than 55 million people have dementia worldwide, and every year, there are nearly 10 million new cases, according to the World Health Organization.

This is a huge number of people, but are there many more people undiagnosed?

Estimates for undiagnosed dementia are ever-changing and vary significantly. Back in 2017, an analysis in the British Medical Journal looked at 23 studies, including 11 in Western Europe and 10 in North America, assessing undetected dementia cases in 43,446 people living with dementia. Results showed:

  • At that time, for every two patients diagnosed with dementia, there were an estimated three people undiagnosed
  • The rate of under-detection was higher among younger ages
  • The rate of under-detection was higher among men
  • Under-detection occurred despite visits to physicians

Why is dementia remaining undiagnosed?

Firstly, “a person with symptoms of dementia might be reluctant to seek a diagnosis because they are afraid of how they might be treated once they are diagnosed,” according to Dementia UK’s website. Is there a culture of shame and embarrassment around dementia?

Medical staff, family and friends still need to learn how to offer the right support to people with dementia. Regular cognitive health checks for older people would help us all to talk more about dementia. If a quick cognitive test could be done regularly as part of annual health screening, this would catch the symptoms that patients are reluctant to talk about.

Secondly, not all memory problems are dementia.

Memory problems, confusion, and apathy are symptoms of dementia, but, as the Dementia UK website points out, they are also symptoms of “infections, delirium, vitamin deficiency, depression, anxiety and diabetes.” These conditions can all be treated.

Thirdly, the symptoms of early-stage dementia can look like the natural aging process:

Early-stage dementia

We all forget things a little bit more as we get older. When a person has dementia, this becomes more extreme: commonly, people struggle to find glasses or keys repeatedly or even forget to turn the oven off. Important birthdays are no longer fixed in the mind. Many people feel upset and useless. Family members are often anxious and worried about changes in their loved one.

Often, a person with early-stage dementia will struggle to make decisions and will need help organizing finances.

Most of us want to be independent and find accepting help difficult.

Middle-stage dementia

A person with middle-stage dementia needs more support and help with the following:

  • Dressing themselves
  • Going to the toilet
  • Eating

Agitation and wandering are common as dementia progresses. It is not easy to see a loved one in this state, and carers often need outside support.

Disturbed sleep is also frequently part of this stage of dementia, which makes caring for someone in their own home increasingly difficult. At this stage of dementia, carers can often suffer from anxiety and stress.

Some people with dementia find social situations difficult: they feel unable to follow conversations and sometimes struggle to communicate with friends and family. Understandably, a person with dementia can have low moods. “Depression, anxiety, and apathy symptoms are highly prevalent across dementia stages,” Dr. Dara K.Y. Leung reports in the International Journal of Geriatric Psychiatry.

Late-stage dementia

The late stage of dementia, according to the Alzheimer’s Society website, “tends to be the shortest. On average, it lasts one or two years.” It can be incredibly difficult to watch a loved one reach this late stage. That said, if someone has been given the time to put the right support in place, they can live with dignity and comfort even at this late-stage of the disease.

At this late stage, people:

  • Need 24-hour care
  • Have reduced mobility
  • Lose language
  • Need help eating
  • Have difficulty swallowing

Yet Dementia UK stresses that people at this stage can still enjoy family, friends, music, art and pets.

Most people want to know if they have dementia

In a survey of 1,000 people aged 65 and older, 92% wanted early diagnosis. Most people want to understand what is happening to them when they experience memory problems, depression and disorientation.

Often, people are relieved to have an explanation for their symptoms. For those that find the diagnosis troubling, early diagnosis is everything. The UK National Health Service website points out that with treatment and support from healthcare providers, family, and friends, many people can lead active, fulfilling lives with dementia.

Why not test regularly for dementia?

There are national screening programs for a variety of serious diseases. Yet while many people worry about getting dementia and worry about finding out soon enough, there is currently no such screening program for this all-too-common condition.

Why are older people not regularly given cognitive testing for dementia?

The obvious answer is: time and money. Healthcare providers are already overloaded, and an initial assessment can take considerable amounts of a physician’s time and expertise. Not to mention the cost of diagnostic tools such as blood tests or brain scans.

But things are changing.

Assessing for dementia can take as little as three minutes

Healthcare providers have been using the traditional clock drawing test (CDT) for many years as a cognitive assessment. The digital CDT, developed by Linus Health, modernizes this test and makes it easier to administer and the results more consistent and sensitive.

The DCTclock™ doesn’t have to be administered by a physician. It’s simple to use and only takes three to eight minutes, making it easy to incorporate into a regular check up.

Vitally, the DCTclock also uses AI to automatically interpret the results and can track small changes over time. And it’s this that gives patients and physicians alike the chance to intervene early, potentially slow cognitive impairment, and make considered plans for the future.

The benefits of prompt diagnosis are enormous

Early diagnosis is vital for effective treatment. A new drug, Leqembi, has been approved for the treatment of early-stage Alzheimer’s disease in the USA. Leqembi is a breakthrough treatment for Alzheimer’s, as it is the first drug to address the underlying biology of Alzheimer's and to slow the progress of the disease. This is a huge step forward for people with an early diagnosis.

Older treatments are also most effective with a prompt diagnosis of dementia. These treatments address symptoms, which can be enormously helpful to both the person with dementia and their loved ones.

Even before dementia has developed, the DCTclock detects mild cognitive impairment and it is at this stage that people can make lifestyle changes which minimize their chance of developing dementia. The World Health Organization recognized this when it stated: “Studies show that people can reduce their risk of cognitive decline and dementia.”

The DCTclock gives people a prompt, accurate diagnosis of mild cognitive impairment and early-stage dementia. It gives people time to organize finances; make decisions about future care; spend quality time with family and friends, or even take a very special holiday.

We want to live healthy lives both physically and cognitively

Early diagnosis empowers people to make their own choices about the future. It allows people to receive the best possible treatment. Cognitive testing needs to be reliable, time-efficient, and affordable: the digital DCTclock has an important role to play in providing patients with that vital early diagnosis.

Learn more about Linus Health’s approach to brain health now.