Adults over 65 face many health risks, so screening this population for each condition associated with aging can be challenging, especially when you only get 15 minutes with a patient once or twice a year.
As a result, research shows primary care providers fail to recognize between 27 and 81 percent of cases of a patient displaying signs of cognitive impairment. This stat is harrowing for many reasons, not the least of which is that the sooner dementia is detected, the more effective treatment will be.
Screen adults 65 and older for dementia once a year
To encourage more early diagnoses, for the first time, the American Academy of Neurology (AAN) is recommending all providers who provide neurological treatment screen every patient 65 and older for cognitive impairment once a year. The complete quality improvement assessment was published in Neurology.
It’s a big step, and one that Marie Carmel Garcon, DNP, FNP, professor at Columbia Nursing School, who specializes in gerontology, fervently agrees with. Dr. Garcon stresses that screening is crucial to protect patients from other risks of the condition — such as falling, malnutrition, financial and physical abuse, isolation and failure to adhere to treatment plans for other chronic diseases.
“With Alzheimer’s and dementia comes so much,” she adds.
That said, Dr. Garcon does recognize the time constraints providers are up against, especially when an older patient is already suffering from hypertension, diabetes or high cholesterol. “Of course, then you’re focused on that,” she says.
How to screen for Alzheimer’s and dementia
Luckily, there are many screeners available that take only a few minutes. Dr. Garcon prefers the Self-Administered Gerocognitive Examination (SAGE) because is “very fast and reliable.” It takes about four minutes, and patients can complete it by themselves or with assistance.
She also advocates for the better-known Mini-Mental State Exam, which can take up to seven minutes. If that’s too long, the Mini-Cog needs only three. And last, there’s the five-question Brief Alzheimer’s Screen, which is easy to score.
Even if a dementia screening isn’t on your agenda for a certain patient, Dr. Garcon says to watch for a few indicators that you should add it. In her experience, sudden changes in appearance, for example, if a patient all of a sudden appears disheveled, is a sign. Also look for forgetfulness, confusion of place and time, appetite loss, paranoia and personality changes.
Screenings are most successful if you’ve built a relationship with your patient, Dr. Garcon adds. That’s why it’s ideal for PCPs to perform them. When asking questions or talking with patients about their responses, “don’t accuse them or try to argue,” Dr. Garcon advises. “Ask them what they think, give them time to explain and show empathy.”
Referring patients to a specialist
If you’ve screened a patient a couple years in a row and have noticed a decline, then involve a neurologist, Dr. Garcon says. Noticing any of the four As of Alzheimer’s — amnesia, apraxia, aphasia and agnosia — is another sign specialized care might be needed.
Because dementia is such a complicated condition, many providers assume only specialists should deal with it, but that’s a disservice to patients. As Dr. Garcon explains it, “Primary care providers are in the best position to intervene early on. You’re the first one who’s going to see the changes.”
Alzheimer’s Association recommendations for operationalizing the detection of cognitive impairment during the Medicare Annual Wellness Visit in a primary care setting, The Journal of the Alzheimer’s Association.