Nearly everyone who suffers from mild cognitive impairment (MCI) does not get a proper diagnosis, which can increase their chances of developing Alzheimer’s disease later in life.
Two recent studies have found that 92 percent of people who experience MCI – a condition in which a person has mild problems with memory and decision-making – which can develop over time into dementia are not diagnosed at an early stage, which could prevent people from accessing new treatments that could slow cognitive decline if caught early enough.
In the first studyresearchers used data from the Health and Retirement Study, a long-term study of 20,000 people in the US, to build a model using a wide range of health and age factors that increase the number of expected MCI diagnoses among people over 65 years predicted. The team determined that 8 million people would have the condition.
They then analyzed data from Medicare participants aged 65 and older in the program between 2015 and 2019 to determine how many people were actually diagnosed with MCI.
When they compared their data, they found that MCI was missed 92 percent of the time. Only eight percent of people who their model predicted would develop MCI were actually diagnosed with the condition – indicating that around 7.4 million people were experiencing cognitive decline but were unaware of it.
Ying Liu, a statistician at the University of Southern California and a researcher on both studies, said, “We knew it was bad, but we didn’t know it was that bad.”
The scientists also found that the rate of missed cases was even higher among black and Hispanic enrollees.
The second studyalso published by Liu and his team, examined Medicare claims from 226,756 primary care physicians with patients aged 65 and older and compared MCI diagnoses to their model.
Again, they found that only eight percent of predicted cases were actually diagnosed with MCI. Furthermore, they found that only 0.1 percent of doctors diagnosed the condition as often as the team calculated.
People with MCI have minor problems with their mental abilities, such as memory and thinking. In these people, the problems are worse than normally expected for a healthy person of their age, but not severe enough to be classified as dementia.
The Alzheimer’s Society estimates that between five and twenty percent of people aged 65 and older live with MCI.
Although not a form of dementia, people with MCI are more likely to develop dementia, including Alzheimer’s, later in life. However, if people are diagnosed with MCI early, they may be able to make lifestyle changes to reduce their risk.
Dementia affects an estimated 7 million people in the US, while approximately 5.8 million Americans have Alzheimer’s disease.
And autopsies often show that people who die in old age have some form of impaired cognition, including amyloid plaques – a hallmark sign of Alzheimer’s disease.
While people who have trouble remembering family members or who get lost can undergo cognitive tests, brain scans and blood tests to be diagnosed with dementia or Alzheimer’s disease, diagnosing MCI is more difficult.
People may notice that something is wrong, but the symptoms are not severe enough to cause alarm – and they can most likely still function independently. Because of this, many people with MCI often only visit their primary care physicians, rather than specialty memory care clinics.
GPs may not see many dementia patients or have no experience with MCI, causing a person’s condition to be missed.
A separate study reported that a patient’s cognitive status was formally assessed in less than a third of doctor visits. However, recent guidelines recommend that a cognitive assessment be carried out at annual wellbeing checks.
The researchers of the two recent studies said: ‘Increased efforts to detect MCI earlier are desperately needed, especially for socio-economically disadvantaged groups, who are at greater risk of missed diagnoses.’
Previous research has found that older black Americans are twice as likely to develop Alzheimer’s disease or other forms of dementia than older whites. Older Hispanics are about 1.5 times more likely to develop the disease than their white counterparts due to confounding factors such as comorbidities and social aspects such as racism and discrimination.
Dr. Keith Vossel, program director for Alzheimer’s disease at the department of neurology at the University of California, Los Angeles, previously told DailyMail.com that education and communication are two major barriers to overcome in the minority population and the healthcare community when it comes to Alzheimer’s diagnosis and treatment.
While distrust leads to a lack of communication, Dr. Vossel says people in minority groups often ask why there aren’t doctors “who look like them” working with dementia patients.
He added: ‘Unfortunately there are not enough neurologists and dementia specialists from underrepresented groups. Doctors must be able to identify with their community.’
In addition to a lack of minority physicians, there is also a lack of access to physicians and healthcare facilities in general.
Addressing the high rates of dementia among minority groups will require a multifaceted approach and Dr. Vossel said this will require everything from establishing a stable education system that meets the needs of all its students, developing measures to combat heart disease and diabetes – comorbidities that can contribute to dementia – conducting screenings for dementia in routine doctor visits and allowing doctors to be reimbursed for those screenings.
However, there may be hope for people who develop dementia. An experimental Alzheimer’s drug developed by Eli Lilly slows cognitive decline by more than a third, the company announced in May.
In a phase 3 trial, the drug, donanemab, slowed the decline in patients’ ability to think clearly and perform daily tasks by 35 percent compared to a placebo.