Findings from the Alzheimer’s Association’s 2019 Alzheimer’s Disease Facts and Figures report show that, despite a strong belief among seniors and primary-care physicians that brief cognitive assessments are important, only half of seniors are being assessed for thinking and memory issues, and much fewer receive routine assessments.

In addition to providing an in-depth look at the latest national statistics on Alzheimer’s prevalence, incidence, mortality, costs of care and impact on caregivers, the new report, which was released in March, examines awareness, attitudes, and utilization of brief cognitive assessments among seniors age 65 and older and primary care physicians.

A brief cognitive assessment is a short evaluation for cognitive impairment performed by a healthcare provider that can take several forms — including asking a patient about cognitive concerns, directly observing a patient’s interactions, seeking input from family and friends or using short verbal or written tests that can be administered easily in the clinical setting.

An evaluation of cognitive function is a required component of the Medicare annual wellness visit, but findings from the report show that only 1 in 3 seniors are aware these visits should include this assessment. 

The report also found, however, that among seniors and primary-care physicians, there is widespread understanding of the benefits of early detection of cognitive decline and the importance of brief cognitive assessments. In fact, 82 percent of seniors believe it is important to have their thinking and memory checked, and nearly all primary care physicians (94 percent) consider it important to assess all patients age 65 and older for cognitive impairment.

“While it’s encouraging to see that the vast majority of seniors and physicians understand the value of brief cognitive assessments, we’re still seeing a significant gap in those that actually pursue, perform or discuss these assessments during routine exams,” said Dr. Joanne Pike, chief program officer for the Alzheimer’s Association. “Early detection of cognitive decline offers numerous medical, social, emotional, financial and planning benefits, but these can only be achieved by having a conversation with doctors about any thinking or memory concerns and through routine cognitive assessments.”

The report found that just 1 in 7 seniors (16 percent) say they receive regular cognitive assessments for memory or thinking issues during routine health checkups, compared with blood pressure (91 percent), cholesterol (83 percent), vaccinations (80 percent), hearing or vision (73 percent), diabetes (66 percent) and cancer (61 percent).

The Facts and Figures report also reveals a troubling disconnect between seniors and primary care physicians regarding who they believe is responsible for initiating these assessments and reticence from seniors in discussing their concerns.

The survey found that while 51 percent all seniors are aware of changes in their cognitive abilities — including changes in their ability to think, understand or remember — only 40 percent have discussed these concerns with a healthcare provider, and 15 percent report having ever brought up cognitive concerns on their own.

Instead, most seniors (93 percent) say they trust their doctor to recommend testing for thinking or memory problems, if needed. Yet fewer than half of primary-care physicians (47 percent) say it is their standard protocol to assess all patients age 65 and older for cognitive impairment. Only 1 in 4 seniors (26 percent) report having a physician ever ask them if they have any concerns about their cognitive function without seniors bringing it up first.

“The findings indicate there are missed opportunities for seniors to discuss cognitive concerns and problems in the exam room,” said Pike. “We hope the report will encourage seniors and physicians both to be more proactive in discussing cognitive health during the Medicare annual wellness visit and other routine exams.”

Nearly all physicians said the decision to assess patients for cognitive impairment is driven, in part, by reports of symptoms or requests from patients, family members and caregivers. Physicians who choose not to assess cognition cite lack of symptoms or complaints from a patient (68 percent), lack of time during a patient visit (58 percent) and patient resistance (57 percent) as primary factors.

In addition, most physicians say they welcome more information about assessments, including which tools to use (96 percent), guidance on next steps when cognitive problems are indicated (94 percent) and steps for implementing assessments efficiently into practice (91 percent).