From: unk...@googlegroups.com   
      
   November 26, 2014   
      
   Why do so many seniors with memory loss and dementia never get tested?   
      
      
      
      
   Despite clear signs that their memory and thinking abilities have gone   
   downhill, more than half of seniors with these symptoms haven't seen a doctor   
   about them, a new study finds.   
   University of Michigan researchers and their colleagues say their findings   
   suggest that as many as 1.8 million Americans over the age of 70 with dementia   
   are not evaluated for cognitive symptoms by a medical provider, which in some   
   patients can lead to a    
   failure to uncover modifiable causes of thinking or memory impairment.   
   The study, published online in Neurology, the medical journal of the American   
   Academy of Neurology, documents a clear lack of clinical testing for seniors   
   with signs of cognitive problems.   
   Those who were married, and those with the worst levels of dementia symptoms,   
   were more likely to have had their memory and thinking ability evaluated by a   
   primary care doctor, neurologist or psychiatrist. The study included people   
   with mild cognitive    
   impairment through severe dementia, from all causes.   
   "Early evaluation and identification of people with dementia may help them   
   receive care earlier," says study author Vikas Kotagal, M.D., M.S., who sees   
   patients at the University of Michigan Health System and is an assistant   
   professor in the U-M Medical    
   School's Department of Neurology. "It can help families make plans for care,   
   help with day-to-day tasks including observed medication administration, and   
   watch for future problems that can occur. In some instances, these   
   interventions could substantially    
   improve the person's quality of life."   
   Free dementia clinical testing now available to all seniors in Medicare   
   The data in the study come from before the start of Medicare's free annual   
   wellness exams for seniors, which began in 2011 under the Affordable Care Act   
   and are required to include a cognitive evaluation.   
   Even so, says Kotagal, "The results of this study have implications in both   
   primary care and specialty care settings. Recognizing cognitive impairment in   
   older individuals is important, and physicians should explore reasons why   
   dementia has occurred and    
   communicate these findings clearly with patients and family members so that   
   they can take this information with them when they leave the office."   
   More about the study population   
   The study was part of a larger, nationally representative, community-based   
   study called the Health and Retirement Study, based at the U-M Institute for   
   Social Research. From that study, 856 people age 70 and older were evaluated   
   for dementia, including a    
   video interview and standard testing. For each participant, a spouse, child or   
   other person who knew the person well was asked whether the participant had   
   ever seen a doctor for any concerns about memory or thinking.   
   A total of 297 of the participants met the criteria for dementia. Of those, 45   
   percent had seen a doctor about their memory problems - and the more severe   
   their issues, the more likely they had had that evaluation. By comparison, 5   
   percent of those with    
   memory and thinking problems that did not meet the criteria for dementia had   
   been tested by a doctor for those issues, and 1 percent of those with normal   
   memory and thinking skills had undergone testing.   
   People who were married were more than twice as likely to undergo cognitive   
   evaluations as people who were not married. Why? "It's possible that spouses   
   feel more comfortable than children raising concerns with their spouse or a   
   health care provider,"    
   said Kotagal. "Another possibility could be that unmarried elderly people may   
   be more reluctant to share their concerns with their doctor if they are   
   worried about the impact it could have on their independence."   
   Other demographic factors did not have an effect on whether or not people had   
   cognitive evaluations, including race, socioeconomic status, the number of   
   children and whether children lived close to the parents. "Our results show   
   that the number and    
   proximity of children is no substitute for having a spouse as a caregiver when   
   it comes to seeking medical care for memory problems for a loved one," Kotagal   
   said.   
   Next stop: Finding out why   
   While the study doesn't answer the question of why people with signs of   
   dementia don't get tested, Kotagal suggests that many factors may be involved   
   - - some driven by the patient, some by physicians, and others by the nature   
   of our health system.   
   Many patients and physicians, he says, may perceive that clinical cognitive   
   exams don't have enough value. But experts have shown that they can improve   
   medical outcomes and help reduce societal costs.   
   For instance, knowing that a stroke or vascular issues in the brain caused   
   dementia means patients can work to control risk factors like blood pressure   
   that might otherwise cause it to keep worsening.   
   The next steps in research on this topic are to find out why patients don't   
   get tested, and what parts of the diagnostic process are most valuable to   
   patients and caregivers.   
    Explore further: How is depression related to dementia?   
   Journal reference: Neurology     
   Provided by University of Michigan Health System    
      
      
   http://medicalxpress.com/news/2014-11-seniors-memory-loss-dementia.html   
      
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