Only Half of Seniors With Signs of Dementia Are Being Tested

Cognitive Tests Now Included in Medicare’s Annual Wellness Exam

Medicare's free annual wellness exam now includes cognitive evaluations.

Medicare’s free annual wellness exam now includes cognitive evaluations.

A University of Michigan study finds that as many as 1.8 million Americans over the age of 70 with dementia have not been evaluated by a doctor. The study was published online in Neurology, the medical journal of the American Academy of Neurology.

Data from the study come from before the start of Medicare’s free annual wellness exams for seniors, which began in 2011 under the Affordable Care Act and are required to include a cognitive evaluation.

We sat down with neurologist Vikas Kotagal, M.D., M.S., one of the co-authors of the study, to talk about cognitive evaluations and the results of the study. Kotagal sees patients at the University of Michigan Health System and is an assistant professor in the U-M Medical School’s Department of Neurology.

What can patients and families do if they think their relative may have dementia?

The best thing you can do is to recommend that your relative take advantage of Medicare’s free annual wellness exams for seniors. You can just bring it up as part of regular conversation, without even mentioning the concerns about memory. People just need to contact their regular primary care doctor to set this up. The exam is required to include some sort of brief cognitive evaluation. 

If you’re close enough to the relative (or his or her spouse) to voice your concern about what you’ve observed, do it in private and gently, and with an emphasis on the idea that getting diagnosed early can really help.

When is it time to call the doctor?

If a family member needs more help with tasks that they have always been able to handle—specifically because of thinking/memory problems—it would be useful to schedule a visit to discuss this with their physician. A referral to a neurologist or psychiatrist may also be a good idea.

What are the benefits of early evaluation and identification?

Early diagnosis means that people can get help sooner. It also reduces the cost to society.

Keep in mind that some age-related cognitive impairment is actually due to reversible causes that look like dementia—such as the side effects of certain medications. The effects of depression and some sleep disorders can also look like dementia. Many of these conditions can get better with medical management.

Finally, cardiovascular risk factors cause many dementias. If we identify these risk factors and modify them in at-risk individuals, we can change the natural history of the disease.

How can physicians help?

Physicians can encourage patients and/or family members to take functionally impairing cognitive symptoms seriously, and not simply ascribe them to the expected effects of old age.

In your study, what types of people were more likely to be tested?

Married people were most likely to be tested for dementia.

Surprisingly, having children who live near you made study participants slightly less likely to be evaluated by a physician for cognitive concerns. I would have guessed the opposite, but after thinking it over, this makes sense too.

People who live close to their kids may find that their children gradually take over certain responsibilities inherently tied to cognitive functions—banking, doing the bills, driving, etc. This conceivably would allow for a greater “safety net” in the event that one develops dementia.

Individuals who develop dementia but who live far away from their children may not have that luxury and subsequently may end up seeking care through their doctor sooner. The number of children and whether children lived close to their parents did not seem to make a difference.

Neither did race or socioeconomic status.

But now, Medicare’s free, annual wellness exams for seniors make it possible for everyone who appears to have symptoms of dementia to have that important cognitive evaluation.

Take the next steps

  • If you suspect that your relative has dementia, talk with him or her, their spouse or partner, and their doctor, as appropriate, using Dr. Kotagal’s guidelines, above.
  • If you are interested in learning more about Alzheimer’s disease and dementia, visit Michigan Alzheimer’s Disease Center.

Vikas Kotagal, M.D., M.S., assistant professor of neurology in the University of Michigan Department of Neurology, sees outpatients with movement disorders including Parkinson’s disease, atypical Parkinsonian conditions, tremor and gait impairments. He directs a subspecialty clinic for patients with suspected normal pressure hydrocephalus. He is passionate about issues impacting access to care for patients with neurodegenerative conditions.


new_logos_180x1806For more than 160 years, the University of Michigan Health System has been a national leader in advanced patient care, innovative research to improve human health and comprehensive education of physicians and medical scientists. The three U-M hospitals have been recognized numerous times for excellence in patient care, including a #1 ranking in Michigan and national rankings in many specialty areas by U.S. News & World Report.