The Challenges to Identifying Dementia, Alzheimer-Risk Patients

The presence of dementia and Alzheimer’s disease is already greater in the US than its rate of diagnosis. But with an aging generation approaching greater risk levels and screening methods remaining imperfect, the pressure to better parse memory-loss presentation is increasing.

In an interview with HCPLive at the American Psychiatric Association (APA) 2022 Annual Meeting in New Orleans this week, Brent Forester, MD, MSc, chief of the division of geriatric psychiatry at McLean Hospital, discussed the importance of adequate screening in older patients complaining of memory loss. As he noted, the Alzheimer’s disease patient population is anticipated to reach 15 million Americans by 2050. Approximately $340 billion annually is dedicated to care for the current population.

“This one condition alone, which represents the sixth-leading cause of death in the United States, will become an economic catastrophe unless we can find a way to diagnose people early and intervene in a way that stops the disease in it tracks or treats it,” Forester said. “But the most important thing is assessing it.”

Forester explained that memory complaints are often associated with normal signs of aging by loved ones, but it’s important to be addressed in the primary care setting, followed by a thorough evaluation; memory loss can be a symptom of anything from a thyroid issue, to anxiety and depression, or even alcohol and substance abuse.

“The way I think about memory problems is it’s the tip of the iceberg, and there’s a whole world underneath that we’ve got to discover what’s driving it,” Forester said.

The care gets trickier when the diagnosis is dementia or Alzheimer’s disease. Approximately half of all Americans with Alzheimer’s are not diagnosed, and many are diagnosed at point when disease pathology has been present in the brain for 2 decades already.

There is no single blood test nor scan available for the disease, and the last decade has been laden with scrutiny over consideration of population-based testing for dementia with available cognition tools generally used for identifying the first risks of diagnosis. This could lead to many false positives, Forester said.

“So increasingly, people are developing targeted screening approaches using algorithms that involve going into the electronic medical record and pulling out components of medical history that might put people at risk of dementia,” he explained. “The question is, how do you create a simple package—an algorithm, almost—that a primary care physician can follow so they don’t feel lost?”

The idea with these proposed screening tools would be to help process patients and their loved ones to resources and care teams that can help address the cognitive burdens of dementia, while attending to retained quality of life.

From there, services like Alzheimer’s Association Dementia Care Consultation program could provide families with assessments linked back to primary care physicians that serves as a “road map” for all involved parties, Forester said.

Forester also highlighted some currently available collaborative care models that could provide timely, prompt, and financially-sound care for new patients with dementia or Alzheimer’s disease. That said, much more work needs to be done at the systemic level to actually make these pathways to care feasible for the anticipated boom of patients.

“These models we know work—they save money and they improve quality of life,” he said. “The 2 things are, how do you pay for them and how do you implement them into a system of care that already exists and is disincentivized to work in this way? We need a new financial model of care to pay for these types of intervention.”