Ask your primary care provider about screening for signs of cognitive impairment


(BPT) - By Dorsey Griffith

In a cruel irony, one of the most significant health challenges facing older Americans is also one of the least diagnosed, especially in the early stages when steps can be taken to slow or better manage decline.

Cognitive decline, a condition that can progress to dementia or Alzheimer’s Disease, is on the rise. An estimated 8 million Americans have mild cognitive decline, and 90% of them don’t know it. As the population of older adults surges, rates of Alzheimer’s disease in the U.S. are expected to skyrocket as well, nearly tripling to 14 million by 2060.

In a busy rural Alabama primary care clinic, Rick Kilgore, a physician associate/assistant (PA), is addressing the disparity by screening every patient over age 50 for signs of cognitive decline or dementia. He’s using a recently developed cognitive assessment screening tool designed for healthcare providers across practice settings. The goal is to improve cognitive screening rates to catch early signs of dementia so that patients can make lifestyle changes to optimize brain health, get referrals to specialists and engage family members or caregivers for support.

“I would estimate that less than 10% of people who go on to develop dementia or Alzheimer’s as older adults are diagnosed with cognitive decline in their 50s or early 60s,” he said. “Usually by the time a family member comes in and says their loved one is having problems, it’s gone beyond losing car keys or forgetting where they parked their car — like forgetting to take their medications. These patients need to be identified earlier so they can take appropriate action, which might include additional tests, lifestyle changes or medications.”

American Academy of Physicians Associates (AAPA) CEO Lisa M. Gables, CPA, says clinicians across the healthcare team, including PAs, are essential to early detection.

“PAs are often one of the first healthcare providers a patient will encounter and are skilled in identifying signs of early cognitive decline in patients and refer them for more testing and treatment,” Gables said. “Just like with other diseases, early detection is critical.”

The cognitive assessment toolkit was developed by the AAPA and Cleveland Clinic with funding from a Davos Alzheimer’s Collaborative (DAC) grant, an initiative of the DAC Healthcare System Preparedness Project. The project aims to advance how healthcare systems worldwide detect, diagnose, treat and care for people with or at risk for Alzheimer’s.

In addition to the patient screening test, the toolkit also allows providers to interpret the findings and differentiate among signs of normal aging, cognitive impairment and dementia. Providers can also discuss abnormal screening results with patients and their caregivers, address any concerns they might have, as well as help them with modifiable risk factors for dementia.

The toolkit also includes resources for patients with information on supporting brain health and wellness.

“The reality is not everyone has to deteriorate,” said Kilgore. “You can slow it down by taking steps like moderate drinking, a healthy diet and daily exercise. My approach is to recommend patients don’t smoke, take walks, read books — don’t be a couch potato. Having good heart function and being mentally sharp are tied closely together.”

The cognitive assessment toolkit was tested at five rural practice sites in Alabama, Idaho, Maryland, Oregon and Tennessee, along with several urban Cleveland Clinic locations. During initial testing, patients 65 and older who were offered a cognitive screening during a yearly wellness exam increased to 100% and those offered a cognitive screening during any type of primary care medical visit increased from 30% to 39%. Eighty-two percent of providers who tested the toolkit said they planned to change their screening practices. The toolkit was officially launched in Fall 2023.

"If patients or their caregivers feel that an individual is showing signs of forgetfulness such as not taking medications, being unable to balance their checkbook or asking repetitive questions, they should alert their provider that the patient may have early signs of cognitive decline,” Kilgore said. “Early screening is important. Even in their 50s, an individual may begin to show subtle changes that can be documented and followed with the screening tools that we have launched within the PA community."