Image of doctor consulting her patient

Clinicians are not proactive in engaging patients on the subject of memory concerns, missing a key chance for timely dementia diagnosis and possible treatment, according to an Alzheimer’s Association report released Wednesday.

The issue has become more urgent with the approval of new treatments for Alzheimer’s, according to Maria C. Carrillo, PhD, the organization’s chief science officer.

“For the first time in nearly two decades, there is a class of treatments emerging to treat early-stage Alzheimer’s disease,” she said in a statement, referring to the monoclonal antibody drugs Aduhelm and Leqembi. “It’s more important than ever for individuals to act quickly if they have memory concerns or experience symptoms.”

The new 2023 Alzheimer’s Disease Facts and Figures report found that 6.7 million people ages 65 years and older have Alzheimer’s dementia in the United States. Care costs are projected to reach $345 billion in 2023 — $24 billion more than in 2022.

Hesitancy and specialist referrals

Focus groups revealed that primary care doctors are hesitant to bring up dementia and memory care concerns, and prefer to wait until patients bring up the issue. Some of this reluctance revolves around a dearth of specialists and concern that there will be few referral options, the report found.

Patients, likewise, do not discuss symptoms of cognitive decline with their healthcare providers, investigators said. Earlier findings revealed a potential reason; many people believe the symptoms are due to normal aging, rather than a diagnosable medical condition.

A shortage of dementia care specialists will add to the problem, the report also found. With a growing number of people diagnosed with dementia, a scarcity of clinicians who can recognize and act during early-stage disease could become a care crisis, the association said.

Treatment accessibility

The newest Alzheimer’s treatments target the biology underlying Alzheimer’s dementia and are approved for use in early-stage disease. Although Medicare coverage is severely limited for both Aduhelm and Leqembi, the Alzheimer’s Association is pushing for wider accessibility to the drugs. 

Discussions about cognition should be a routine part of clinical care, according to neurologist Nicole Purcell, DO, the organization’s senior director of clinical practice. 

“These new treatments treat mild cognitive impairment or early-stage Alzheimer’s disease with confirmation of amyloid, so it’s really important that conversations between patients and doctors happen early or as soon as symptoms occur, while treatment is still possible and offers the greatest benefit,” Purcell said.

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Dementia to cost nation $321 billion this year, Alzheimer’s Association says (2022)