Research has shown that the majority of Americans would want to know if they have Alzheimer’s disease (AD) so that they could take advantage of early treatments. Yet, most people experiencing cognitive issues are reluctant to share their concerns with their primary care physician (PCP), the providers on the front lines of diagnosing AD.
While there is no cure for AD, early diagnosis offers access to clinical trials and medication, such as aducanumab and the newly-approved lecanemab, that is available to slow the progression of those with mild or early-stage AD.
If patients are hesitant to share their concerns with their PCPs, that leaves early detection up to the doctors. But, they, too, are reluctant to address cognitive issues. According to a 2023 Alzheimer’s Association Special Report, nearly all PCPs wait for their patients or family members to bring up symptoms or concerns. How can patients and doctors move past this standoff?
Why don't patients or doctors want to talk about memory problems?
In most cases, for patients, it’s simply that they perceive their cognitive issues as “normal aging.” They expect the issues to resolve or wait for them to get worse. Sadly, there is still a stigma attached to dementia and cognitive issues that make many reluctant to share their experiences or concerns. And lastly, patients reported a fear of receiving an incorrect diagnosis or any diagnosis and subsequently having to take medication.
As for the PCPs, they conveyed that they don’t have time to perform a thorough cognitive assessment. Also, many PCPs do not have the skillset or tools to perform one. Fortunately, newly available digital technologies, such as Neurotrack’s 3-Minute Cognitive Screening, can help PCPs perform an evaluation in a timely fashion and also feel more confident in their diagnosis.
How can PCPs break the dementia diagnosis standoff?
To start, PCPs can begin a clinical visit with a casual social conversation, which can put their patients at ease and may get them to reveal important cues regarding their cognitive health. Once a patient opens up or shares a concern or incident, the provider can then ask more pointed questions to determine if an assessment is necessary. Or, better still, primary care practices can make a quick, digital screening routine for all adults 65+, so no one feels singled out.
A key component to helping PCPs in diagnosing dementia is having a family member join the exam. According to the Alzheimer’s Association’s report, not only are family members better able to communicate vital information regarding their loved one’s memory issues, but the patient is also generally more accepting of the need to address those issues when a family member attends their visit.
Lastly, PCPs need to be mindful of cultural differences and biases. For example, while older Black adults are almost twice as likely to get AD as older White adults, Black adults have unique reservations about sharing memory or cognitive issues because of historical racism in the medical field. Sensitivity and awareness around these issues and checking their implicit bias can help PCPs better address cognitive concerns and assessments in people of color.