In a previous post, we discussed how the world is poised to see an unprecedented surge in cognitive care needs. In order to prepare for the related growing gap between specialist supply and patient demand when it comes to brain health needs, we are presenting a series of posts dedicated to the power of early detection of mild cognitive impairment (MCI) and dementia. In the first part of this series, we’ll explore the perspectives of patients and providers around brain health and the need for new approaches to protecting it.
Inside the mind of the patient
Currently, up to 18% of people aged 60 or older live with a form of MCI. While it affects nearly 10 million Americans, fewer than 1 in 5 are familiar with MCI. When provided with a description of MCI, nearly one-half (47%) of US adults say they worry about developing a form of it in the future. Notably, approximately one-third of people who have MCI due to Alzheimer’s disease develop dementia within five years, according to the Alzheimer’s Association.
Interestingly, people’s concerns about developing MCI do not always translate into action. Only 4 in 10 indicate they would immediately talk to their doctor if experiencing symptoms of MCI; over half said they would wait until their symptoms continued or worsened, or until others expressed concern. Nearly 80% of US adults report having general concerns about seeing their doctor when experiencing MCI-related symptoms. These concerns include:
- Receiving an incorrect diagnosis
- Learning of a serious health problem
- Receiving an unnecessary treatment
- Believing symptoms might go away
Despite such concerns around MCI, 85% of older adults say they would want to know early if they had signs of Alzheimer’s disease and a full 54% specified wanting to know as early as the MCI stage. The top reasons people surveyed cited for wanting to know early include:
- Planning for the future (70%)
- Allowing for earlier treatment of symptoms (70%)
- Taking steps to preserve existing cognitive function (67%)
With this data in mind, it’s clear that patients have the desire to better understand their brain health, but are reluctant to raise concerns, particularly early on. This delay in action is one of several barriers to patients receiving earlier interventions — heightening the need for more proactive and objective cognitive assessments to spot problems as early as possible.
Are providers prepared?
Primary care providers play an integral role in providing cognitive care to patients with MCI, with nearly two-thirds reporting they receive questions about MCI-related symptoms each week Unsurprisingly, a full 96% of PCPs say it’s important to assess patients aged 60 and older for cognitive impairment. However, a range of barriers has led to them assessing less than half of patients in this group for MCI.
The vast majority of PCPs (86%) say it is important to diagnose MCI because early intervention can slow progression of cognitive decline. When they detect MCI, nearly three quarters of PCPs recommend lifestyle changes and over half refer patients to a specialist. While research shows that some people with MCI, with intervention, can revert to their normal cognitive abilities, for others, catching it early provides an opportunity to slow the progression of disease.
Despite recognition of the importance of early detection, challenges to more widespread brain health assessments hinder it. Gaps in tools and training are among key barriers, particularly in primary care. In fact, “difficulty in differentiating MCI from normal aging” and “lack of sufficient expertise in performing cognitive assessments” were among the top challenges PCPs cited in diagnosing MCI.
A new approach is key to meeting a growing need
With these challenges, how can PCPs prepare for an increase in cognitive care needs in the communities they serve? To start, it's vital for providers to adopt a more proactive approach to brain health and help patients harness opportunities for more preventative care, such as making lifestyle and health-based modifications. Normalizing regular assessments can help PCPs detect MCI earlier and unlock earlier opportunities to implement changes like these. To make this possible, providers need new, more practical tools to aid them in early detection and intervention.
Traditional paper-based assessments (such as the MMSE or MoCA) have long been used in the detection of MCI, but require significant resources and time, while providing only limited insights. They can be cumbersome and time-intensive and typically require providers to administer them. In contrast, newer digital detection methods are both more efficient and sensitive and offer the added benefit of not requiring providers themselves to administer them — making their incorporation into standard practice more feasible.
In addition to catching signs of cognitive issues early, regular cognitive assessments for older adults allow providers to establish a baseline of patients’ cognitive abilities. They also help facilitate conversations with all older patients about actionable steps they can take in their daily lives to preserve and promote their brain health.
Part 2: Prevention, Intervention, and Care
In our next post, we’ll explore the 2020 Lancet Commission report on dementia prevention, intervention, and care with Joyce Gomes-Osman, PhD, VP of Interventional Therapy at Linus Health. The report identified several modifiable risk factors that might delay or prevent up to 40 percent of dementia cases.