Taking a Proactive Approach to Memory Loss

June 13, 2024 at 12:17 p.m.

Currently, the Alzheimer’s Association is encouraging all Americans to take charge of their brain health. Today, there are nearly 7 million Americans living with Alzheimer’s. The lifetime risk for the disease at age 45 is 1 in 5 for women and 1 in 10 for men.

The brain changes that cause Alzheimer’s are thought to begin 20 years or more before symptoms start, which suggests that there may be a substantial window of time in which to intervene in the progression of the disease. Experts believe there isn’t a single cause of Alzheimer’s. It’s likely that the disease develops as a result of multiple factors. While not a direct cause of Alzheimer’s, the greatest known risk factor is advancing age.

Although some risk factors like age cannot be changed, others can. These include physical activity, not smoking, challenging your mind, keeping blood pressure in check, and eating a healthful diet may be modified to reduce a person’s risk.

“We want people to know there are steps they can take to potentially reduce their risk of cognitive decline. We also want to encourage anyone experiencing memory or thinking problems to talk to their doctor. There are many possible causes, and if it is Alzheimer’s disease, there are numerous benefits to getting a timely diagnosis,” Sam Fazio, who is the senior director of quality care and psychosocial research at the Alzheimer’s Association, Chicago, Illinois.

The Alzheimer’s Association is offering several suggestions for taking charge of your brain health, including incorporating healthy habits that may reduce the risk of cognitive decline. As many as 40% of dementia cases worldwide may be attributable to modifiable risk factors, based on mounting scientific evidence.

Whatever your age or stage of life, now is the time to take charge of your brain health by learning the early warning signs of Alzheimer’s and other dementia. Many people equate Alzheimer’s with memory loss. That is just one of the most common symptoms. There are other warning signs that can signal cognitive decline, including altered judgment, mood changes, challenges in decision-making, and planning and carrying out projects.

Some memory changes can be a normal part of the aging process, but when changes start to interfere with daily living or stray drastically from the person’s normal behavior, it’s best to get it checked. The Alzheimer’s Association suggests that older adults be proactive in addressing memory and thinking problems.

Studies show many individuals experiencing memory and thinking problems often put off discussing them with a doctor. A 2022 Alzheimer’s Association report found that 60% of U.S. adults say they would not see a doctor right away if they were experiencing symptoms of mild cognitive impairment (MCI). Instead, they would wait until symptoms persisted, worsened or until family and friends expressed concern. Getting diagnosed earlier rather than later may provide for better care, management and treatment. It also provides diagnosed individuals more time to plan for the future, and adopt lifestyle changes that may help slow disease progression. Some individuals may want to enter a clinical trial and to live with a higher quality of life for as long as possible.

There are treatments that may slow disease progression for older adults in the early stage of Alzheimer’s, making a timely diagnosis critically important. Today, approximately 55,000 volunteers are needed for more than 180 clinical trials. The Alzheimer’s Association TrialMatch is a free, easy-to-use service that connects interested individuals with appropriate trials.

Just A 5-Minute Test

The underdiagnosis of dementia, especially among Black and Hispanic patients, is a long-standing challenge in medicine.

 Now, a new study published in Nature Medicine is demonstrating that an easy, 5-minute assessment paired with recommendations built into the electronic medical record system led to a three-fold improvement in diagnosis and treatment for patients in a primary care setting compared to a control group. The “5-Cog paradigm,” which was developed by researchers at Albert Einstein College of Medicine and Montefiore Health System in New York City, dramatically enhances the diagnosis of MCI and dementia, and represents a new, better way to guide initial treatment.

“Dementia is often undiagnosed in primary care. Even when diagnosed, it often goes untreated,” said Dr. Joe Verghese, the developer of the 5-Cog paradigm. “Until now, most approaches to detecting cognitive impairment would take a long time, were expensive, and required a neurologist. Since, existing tests were developed in white populations, they don’t account for cultural differences. We’ve tried to address these inadequacies with current tests, and the findings from our study show meaningful progress on all fronts.”

The 5-Cog assessment is a picture-based memory-impairment screening test. Previous research has found that the image-based assessment effectively addresses testing disparities resulting from a person’s preferred language, education level, and gender. Importantly, the assessment can be given by minimally trained non-physician personnel who can convey results to a primary care provider.

The cognitive assessment is paired with recommendations to guide primary care physicians on next steps, including referral to a specialist. The study involved 1,201 older adults (average age 72.8 years) with cognitive concerns and 94% of patients were Black and/or Hispanic/Latino. All of these older adults lived in zip codes designated as socioeconomically disadvantaged neighborhoods.

The individuals were randomly assigned either to the group receiving the 5-Cog approach (599 patients) or to a control group that was not tested. Follow-up over the next 90 days showed that compared with the control group, those patients who had undergone 5-Cog paradigm were three times more likely to have benefited from “improved dementia care actions,” including being diagnosed for MCI or dementia, being referred to specialists, and receiving medications.

“We’re hopeful that the findings from this study could promote changes in primary care practice so that more older people with mild cognitive impairment or dementia will benefit from getting diagnosed and treated for their conditions,” said Dr. Verghese.

John Schieszer is an award-winning national journalist and radio and podcast broadcaster of The Medical Minute. He can be reached at medicalminutes@gmail.com

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