Older adults see the benefit in cognitive screening, but many have not been tested

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Eighty percent of older adults see the benefit of tests that can give an early warning that a person's memory and thinking abilities have started to decline, a new poll of people age 65 to 80 finds. And 60% think that health care providers should offer cognitive screening, in the form of brief memory tests, to all older adults every year.

If they had a cognitive screening test and it showed signs of trouble, the vast majority of those polled said it would spur them to take action to protect their brain health (96%) and adjust their financial and health care planning (75%).

Even so, 80% of older adults said they haven't had a cognitive test in the past year to look for early signs of Alzheimer's disease or other types of dementia, and 59% reported never having had such a screening. Medicare covers brief tests as part of an annual wellness visit available to everyone enrolled, and more comprehensive tests for those with symptoms of cognitive decline.

The findings, from the University of Michigan National Poll on Healthy Aging, are published simultaneously in a new report and a pair of research presentations at the 2023 Alzheimer's Association International Conference in Amsterdam. The poll is based at the U-M Institute for Healthcare Policy and Innovation and supported by AARP and Michigan Medicine, the University of Michigan's academic medical center.

In addition to cognitive screening, the poll team also asked adults aged 65 to 80 what they knew and thought about blood tests that can help detect Alzheimer's disease by looking for biomarkers of the brain proteins tau and amyloid.

Only 17% said they were familiar with such blood tests, less than 1% had had one, and 9% said they would like one now. Currently, only doctors who specialize in brain diseases order such tests for people with objective cognitive impairment, but some experts believe they could become useful for screening or early-stage detection of Alzheimer's disease. Half of those polled said such blood tests should be made available to all adults over 65.

As many as half of Americans with Alzheimer's disease or another form of dementia don't receive a formal diagnosis, even when they have clear symptoms. As more diagnostic and treatment options become available, it's important to understand how older adults view them and how best to support those who undergo testing and receive results."

J. Scott Roberts, Ph.D., associate director of the poll

Roberts, a geropsychologist, is a professor at the U-M School of Public Health and leads outreach and education efforts at the Michigan Alzheimer's Disease Research Center, which is funded by the National Institutes of Health.

The findings come soon after Medicare laid out its plan for covering new drugs approved by the U.S. Food and Drug Administration that may slow cognitive decline in people with early Alzheimer's disease. One of those drugs received approval through the traditional route, which is required by Medicare, earlier this month.

In addition, growing research shows the power of blood pressure control, physical activity, social connection and other factors in reducing risk for cognitive decline in older adults.

Although these options may not work for everyone, only 17% of older adults said cognitive screening wasn't worth it until more treatment or prevention options are available. For blood tests, 20% said the same.

The role of doctors, nurses, and other health care providers in early detection of cognitive problems is key, the poll finds.

"Our findings suggest that more than 80% of older adults look to their health care providers for cognitive screening or blood biomarker testing if they feel it's appropriate," said poll director Jeffrey Kullgren, M.D., M.P.H., M.S., an associate professor of internal medicine at Michigan Medicine and physician and researcher at the VA Ann Arbor Healthcare System. "That expectation, coupled with the growing availability of options after diagnosis of cognitive impairment, supports the current recommendation that providers should be assessing patients at higher risk or with signs of cognitive decline."

He notes that current guidelines for cognitive screening focus on those with symptoms or added risk factors; this recommendation encompasses the kind of screening that involves giving a person a brief set of standardized tasks to test their memory and thinking skills, such as remembering a short list of common words or drawing a complex figure.

Differences in testing

Women were more likely than men to say that they would experience significant distress if a cognitive screening test or blood biomarker test suggested they had early signs of dementia. Overall, about 60% of older adults said they would feel such distress in response to a positive result on either type of testing.

Another disparity seen in the poll data: only 10% of older adults of Hispanic ethnicity reported having received cognitive screening in the past year, compared with 22% of non-Hispanic white respondents and 21% of non-Hispanic Black respondents.

Chelsea Cox, M.P.H., M.S.W., a doctoral student training with Roberts, is presenting additional findings at the meeting in Amsterdam. An in-depth analysis of the poll results found adults aged 65-80 were more likely to report cognitive screening if they were of older age, had higher levels of education, reported being in poorer physical health, had Medicare Advantage coverage (compared to traditional Medicare), and had more positive views in general about screening.

Taken together, these poll findings suggest a need to explore barriers to, and facilitators of, cognitive testing in diverse groups of older adults. One opportunity is to improve awareness of and access to Medicare annual wellness visits, for which detection of cognitive impairment is a required component.

"Everyone should have access to cognitive testing as they age," said Sarah Lenz Lock, senior vice president of Policy and Brain Health at AARP and executive director of the Global Council on Brain Health. "The bottom line is that if we want to improve brain health for all, we have to pay attention to the needs of those at greatest risk of poor health and address barriers that stand in the way."

The poll report is based on findings from a nationally representative survey conducted by NORC at the University of Chicago for IHPI and administered online and via phone in March 2023 among 1,242 adults aged 65 to 80. The sample was subsequently weighted to reflect the U.S. population.

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