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Turkey… with a side of memory loss?

If older relatives at holiday gatherings show early signs of dementia, new research shows the importance of steering them to testing

Thanksgiving memoryAs you gather for Thanksgiving and winter holidays, you might notice that Grandma, Aunt Betty or Uncle Sal seems to struggle more with memory, or thinking, than she or he did last year.

Rather than chalk it up to normal aging, new U-M research suggests you might want to gently suggest they get it checked out by their doctor.

In fact, as many as half of seniors who have these symptoms have never had it checked out fully, new research finds. Dr. Vikas Kotagal, a U-M neurologist who led the new study, says families should encourage seniors with even early signs of memory loss to talk to their doctor.

Q: What did your research find?

A: We found that despite clear signs that their memory and thinking abilities have gone downhill, more than half of seniors with these symptoms haven’t seen a doctor about them.

There’s a clear lack of clinical testing for seniors with signs of cognitive problems, from mild cognitive impairment through severe dementia, from all causes.

 

Q: What do your findings mean for our nation, and for individual families?

A: Our findings suggest that as many as 1.8 million Americans over the age of 70 with dementia are not evaluated for cognitive symptoms by a medical provider. And in some patients, this can lead to a failure to uncover causes of thinking or memory impairment that we can actually modify.

We also found that those seniors who were married, and those with the worst levels of dementia symptoms, were more likely to have had their memory and thinking ability evaluated by a primary care doctor, neurologist or psychiatrist.

These findings are especially concerning because early evaluation and identification of people with dementia may help them receive care earlier. It can help families make plans for care, and get help with day-to-day tasks including making sure that older family members take their medications. It also helps family members watch for future problems that can occur. In some instances, these interventions could substantially improve the person’s quality of life.

 

dementia signsQ: So if I notice during holiday gatherings that an older relative seems more forgetful or disoriented than usual, what can I do?

A: The best thing you can do for an older relative in general is to recommend they take advantage of Medicare’s free annual wellness exams for seniors, which began in 2011 under the Affordable Care Act. You can just bring it up as part of regular conversation, without even mentioning the concerns about memory. They just need to contact their regular primary care doctor, and the exam is required to include a 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.

Recognizing cognitive impairment in older individuals is important, and physicians should explore reasons why dementia has occurred and communicate these findings clearly with patients and family members so that they can take this information with them when they leave the office.

 

Q: Tell me more about your study and what it means.

A: Our research on how many seniors have had clinical testing for dementia was part of a larger, nationally representative, community-based study called the Health and Retirement Study, based at the U-M Institute for Social Research.

From that study, 856 people age 70 and older were evaluated for dementia, including a video interview and standard testing. For each participant, a spouse, child or other person who knew the person well was asked whether the participant had ever seen a doctor for any concerns about memory or thinking.

A total of 297 of the participants met the criteria for dementia. Of those, 45 percent had seen a doctor about their memory problems – and the more severe their issues, the more likely they had had that evaluation.

By comparison, 5 percent of those with memory and thinking problems that did not meet the criteria for dementia had been tested by a doctor for those issues, and 1 percent of those with normal memory and thinking skills had undergone testing.

Even though the people in the study had a wide range of incomes, ethnic and racial backgrounds, education levels and distances from grown children, none of that seemed to factor into their likelihood of getting tested. Only marriage and more severe dementia were associated with a higher chance that they had been tested.

 

Q: Why would married people be more likely to get testing?

A: It’s possible that spouses feel more comfortable than children raising concerns with their spouse or a health care provider. Another possibility could be that unmarried elderly people may be more reluctant to share their concerns with their doctor if they are worried about the impact it could have on their independence.

But, our findings don’t mean that someone other than a spouse can’t help an older adult who may show signs of dementia.

 

Q: Why do you think more people don’t get tested?

A: Many factors may be involved – – some driven by the patient, some by physicians, and others by the nature of our health system.

Many patients and physicians may perceive that clinical cognitive exams don’t have enough value. But experts have shown that they can improve medical outcomes and help reduce societal costs.

For instance, knowing that a stroke or vascular issues in the brain caused dementia means patients can work to control risk factors like blood pressure that might otherwise cause it to keep worsening.

So, the next steps in research on this topic are to find out why patients don’t get tested, and what parts of the diagnostic process are most valuable to patients and caregivers.

 

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UMHEALTHFor 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 national rankings in many specialty areas by U.S. News & World Report.