Early testing has become critical in dementia care

April 07-- Apr. 7--ALBANY -- Findings from the Alzheimer's Association 2019 "Alzheimer's Disease Facts and Figures" report released last month show that, despite a 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 fewer receive routine assessments.

The issue becomes more prevalent as baby boomers age, so it has become reality that early assessment is necessary in order to improve overall quality of life for patients as well as their caregivers.

"This is critical because we have some patients, because of their educational level and overall intelligence, they can mask symptoms," Dr. Derek Heard, a family medicine physician at Phoebe Primary Care of Albany, said. "My father was college educated, and he found ways to complete different tasks.

"Now he has been diagnosed, and we are dealing with that."

The report provides the latest statistics on Alzheimer's prevalence, incidence, mortality, costs of care and impact on caregivers nationally and in Georgia -- while examining 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 health care 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 in the clinical setting.

"(The family) may catch small changes over time," Heard said.

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

"There are new Medicare guidelines for wellness exams, and our organization has been educating to let people know this is something Medicare does pay for," Heard said. "If you have Medicare, you should avail of the free yearly assessment."

Heard said his practice is seeing patients three or four times over the course of a year, often making it the first point of contact when signs of dementia occur. Up until now, the focus in primary care has been on fixing an illness -- but now there is a stronger emphasis on wellness.

For dementia, this may mean earlier intervention. If a patient tells a physician they cannot count money or go to the grocery store anymore, that may be sign further evaluation is needed.

"Anytime you can intervene is good, but the earlier you can intervene the (better chance) of slowing decline," Heard said. "We can get them started on medications, and (there is) time to get them started on social services.

"We are viewing medicine differently. We don't want to treat an illness, we want to prevent it if possible. I am looking for things I did not before."

Early screening for dementia also means an earlier appointment with a neurologist and connections to respite services such as the Alzheimer's Outreach Center in Albany.

"The burden on the family is lessened," Heard said. "We can delay progression. As a child of a patient with dementia, (I can say) it has lessened our burden as a family.

"Having time to do that for the family is vital. The caregivers take the brunt of it."

Nursing home admissions are costly, and resources are often in short supply at places such as the Alzheimer's Outreach Center. And that is a nationwide issue.

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