Recent studies have revealed a shocking truth – mild cognitive impairment, an early stage of dementia, is vastly underdiagnosed among individuals aged 65 and older. One study, based on Medicare data from 2015 to 2019, estimated that only 8% of the expected number of cases of mild cognitive impairment had actually been diagnosed. This translates to approximately 7.4 million undiagnosed cases across the country. Another study found that over 99% of primary care clinicians underdiagnosed mild cognitive impairment in this population. These findings highlight a serious gap in the detection and management of this condition.
Mild cognitive impairment is often an early indicator of Alzheimer’s disease, with about half of cases progressing to dementia. The failure to detect and address mild cognitive impairment can deprive patients of the opportunity to receive treatment and potentially slow down the progression of the disease. Addressing underlying causes, such as medication side effects, thyroid dysfunction, or nutritional deficiencies, is crucial in managing this condition. Additionally, managing risk factors like high blood pressure and cholesterol through medication, diet, and exercise can help reduce the risk of progression.
In 2023, the Food and Drug Administration approved lecanemab as the first disease-modifying treatment for Alzheimer’s disease, the most common cause of mild cognitive impairment. Unlike previous drugs that only managed symptoms temporarily, lecanemab targets the underlying cause of the disease by reducing toxic amyloid plaques in the brain. Clinical trials have shown promising results in slowing down the progression of early-stage Alzheimer’s disease. Another drug, donanemab, is also expected to be approved in 2024. However, these treatments are most effective when used in the early stages of the disease.
Challenges in Timely Detection
Several factors contribute to the underdiagnosis of mild cognitive impairment, including the subtle and slow progression of symptoms that can be mistaken for normal aging. Cognitive tests exist to differentiate between mild cognitive impairment and pathologic decline, but the limited time of a doctor’s visit often makes it challenging to conduct these tests. Families, friends, and individuals themselves need to be vigilant about cognitive changes, raise concerns during medical appointments, and push for formal assessments. The Medicare yearly “wellness” visit provides an opportunity to address cognitive health concerns, yet many beneficiaries fail to take advantage of this opportunity.
Just as unexplained weight loss is taken seriously by physicians, cognitive health concerns should become a standard part of medical evaluations, especially for individuals in their 60s and beyond. The normalization of discussing cognitive changes and advocating for proper assessments is crucial in addressing the hidden epidemic of undiagnosed mild cognitive impairment. By raising awareness, promoting earlier detection, and exploring innovative treatment options, we can improve outcomes for individuals at risk of cognitive decline.
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