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Only about 20% of those aged 65 to 80 had a screening test in the past year to see if their memory and thinking abilities have started to decline, according to the University of Michigan's National Poll on Healthy Aging.
“As many as half of Americans with Alzheimer's disease or another form of dementia don't receive a formal diagnosis, even when they have clear symptoms,” said J. Scott Roberts, associate director of the poll and a professor at the university's School of Public Health.
“As more diagnostic and treatment options become available, it's important to understand how older adults view them and how best to support those who undergo testing and receive results,” he added in a Michigan Medicine news release.
More than 1,200 older U.S. adults provided answers in the poll conducted in March. Among the findings:
- Eighty percent see the benefit of tests for older adults that assess memory and thinking.
- About 60% think that health care providers should offer cognitive, or mental, screening to all older adults every year.
- The vast majority, 96%, said a memory test that showed signs of trouble would cause them to take action to protect their brain health. About 75% said it would lead them to adjust financial and health care planning.
- Nearly three-fifths of respondents said they had never received any screening of their mental abilities.
Medicare covers these brief tests as part of an annual wellness visit for all its enrollees. More comprehensive tests are available for those who show cognitive decline.
Another screening option is to test blood for biomarkers of the brain proteins tau and amyloid, which are linked to Alzheimer's disease.
But only 17% of those polled were familiar with these blood tests. Fewer than 1% had received one. About 9% said they would like one now.
The tests are only ordered by doctors who specialize in brain diseases. These blood tests should be made available to all adults over 65, said more than half of those polled.
"Our findings suggest that more than 80% of older adults look to their health care providers for cognitive screening or blood biomarker testing if they feel it's appropriate,” said poll director Dr. Jeffrey Kullgren, an associate professor of internal medicine at Michigan Medicine.
“That expectation, coupled with the growing availability of options after diagnosis of cognitive impairment, supports the current recommendation that providers should be assessing patients at higher risk or with signs of cognitive decline,” Kullgren said in the release.
Women were more likely than men to say they would experience significant distress if a screening or blood biomarker test suggested they had early signs of dementia. More than 60% of older adults said they would feel such distress.
Researchers also noted an ethnic disparity in testing. Only 10% of older Hispanic adults reported having received cognitive screening in the past year, compared with 22% of white respondents and 21% of Black respondents.
Those polled were more likely to report cognitive screening if they were of older age, had higher levels of education, in poorer physical health, were covered by Medicare Advantage and had more positive views in general about screening, according to additional analysis by doctoral student Chelsea Cox.
The findings suggest a need to explore barriers to cognitive testing in diverse groups of older adults, Cox and colleagues said. Improving awareness of the access to testing at Medicare annual wellness visits could be an option.
The study results were released in a pair of presentations this week at the Alzheimer's Association International Conference, in Amsterdam, the Netherlands. Findings presented at meetings are usually considered preliminary until published in a peer-reviewed medical journal.
The U.S. National Library of Medicine has more on cognitive testing.
SOURCE: Michigan Medicine-University of Michigan, news release, July 19, 2023
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