For people with dementia and their caregivers, taking early action to manage the challenges of the condition can lead to an improved quality of life. Yet many people with dementia are not diagnosed until the later stages.
"There are multiple reasons why dementia may be underdiagnosed," says neurologist Tim Chang, MD, PhD. "These may include the stigma attached to Alzheimer’s disease or people thinking cognitive issues are a part of normal aging.
"Another reason is primary care providers (PCPs) do not have enough time to ask about cognitive health."
To address the latter issue, Dr. Chang and his team have developed a brief questionnaire designed to help PCPs screen for dementia in less than five minutes. In July, it will be introduced at the UCLA Family Health Center in Santa Monica. The longer-term goal is to expand its use to all UCLA Health primary care clinics.
Other members of the team behind the questionnaire include Keith Vossel, MD; Mirella Díaz-Santos, PhD; and Gerardo Moreno, MD.
Meeting a growing need
This type of screening tool is needed more than ever today as the U.S. population ages.
Mild cognitive impairment (MCI) affects 12 to 18% of people ages 60 and older, according to the Alzheimer’s Association. MCI is not the same thing as dementia. However, it may be the first sign that something is wrong. People with MCI experience slightly more of a drop in mental abilities than is typical for their age, but they are still able to do their usual activities. Some (not all) go on to develop dementia.
Dementia is characterized by impaired memory, language and thinking skills. Unlike MCI, it interferes with everyday activities. About one in nine Americans ages 65 and older is living with dementia due to Alzheimer’s disease, the most common form.
This kind of dementia gets worse with time. Eventually, it limits a person’s ability to function in most areas of daily life. The screening tool helps find dementia while it is still at a milder stage. At that point, proactive care and planning can improve patients’ lives. And education can help families prepare for what lies ahead.
Addressing ethnic disparities
Latino and Black Americans are at particular risk. They are 1.5 to 2 times more likely than whites to have dementia. Yet many are not diagnosed until later in the disease. By that time, functional decline and caregiver burden may already be taking a heavy toll.
One aim of the new screening tool is to improve the detection of dementia in these underserved groups. UCLA Family Health Center serves a racially and ethnically diverse population. About 20% of patients are Latino.
Dr. Chang and his team have created a version of their screening tool specifically for these patients. It was translated into Spanish and adapted for Latino culture to more accurately assess cognitive health.
A side benefit of inclusive screening is that it may give more minority patients a chance to take part in research on biomarkers. These are biological changes that may offer very early clues to dementia risk. Such patients have in the past been underrepresented in medical research.
Innovative screening tool
Another thing that sets apart the new screening tool is its ease of use. The tool is integrated into a patient’s electronic health record, which means the PCP has relevant information at hand for making clinical decisions.
The tool itself consists of three questions. They ask about changes in memory/thinking, language or personality within the last five to 10 years. Each comes with examples of common changes to prompt accurate responses. For instance, examples of memory/thinking changes include trouble recalling recent events and repeating oneself often.
Screening will be done once a year in patients ages 60 and older. There are two forms of the questionnaire. The patient completes one. The other is designed to be completed by someone who knows the patient well, such as a family member.
"Many patients with early cognitive issues will not say or believe they have any issues. Having input from an informant who knows the patient well can be very helpful," says Dr. Chang.
But because an informant is not always available, the PCP can also conduct a very short psychological test called the Mini-Cog. This test is already well-established in clinical use.
Benefits of early detection
A “yes” answer to a question (or a positive Mini-Cog score) cannot in itself diagnose dementia. But it does prompt the clinicians that more assessment is needed. The PCP can then do further workup or refer the patient to a specialist.
"Timely diagnosis of dementia is important for several reasons,” says Dr. Chang. “There are medications that can delay some symptom progression. There are also numerous drugs in clinical trials."
In addition, Dr. Chang says, we know that controlling conditions such as heart disease and high blood pressure can help delay the progression of certain types of dementia.
"That may give patients another motivation to stay on top of their health.”
Learn more about dementia care at UCLA Health.
