Artist's representation of amyloid beta plaques on brain nerve cells

Patients and families can benefit from early, accurate diagnoses of mild cognitive impairment, but a new survey finds that many frontline physicians report difficulties distinguishing between cognitive problems due to aging, MCI syndrome, and MCI that is due to Alzheimer’s disease. 

“A variety of factors can cause MCI, so it is viewed as a broad set of symptoms; this can make the diagnosis of MCI challenging for affected individuals and physicians,” wrote the authors of the 2022 Alzheimer’s Disease Facts and Figures report, released last week by the Alzheimer’s Association.

Among 801 primary care physicians surveyed, 75% say they provide care to patients with the broad syndrome of MCI (as opposed to MCI due to Alzheimer’s). And two-thirds say they field questions about the condition on a weekly basis. Most (86%) are on board with early intervention to help delay progression of decline. 

Yet, while 65% of primary care physicians say they are comfortable with diagnosing the condition, less than half (49%) report being comfortable diagnosing MCI that is due to Alzheimer’s. Fully 90% told researchers “it is hard to know where MCI ends and dementia begins.”

Additional barriers to diagnosis include a lack of specialists and facilities to perform diagnostic tests, patient reluctance to pursue follow-up testing, and clinicians’ reluctance to diagnose the condition due to limited treatment options, the researchers reported.

Only half of older patients assessed

Primary care physicians are evaluating just under half of their patients for cognitive impairment, the survey found. Notably, only 7% of physicians reported being “very familiar” with current biomarker tests that can help aid in MCI detection, and only 18% frequently recommend testing for Alzheimer’s biomarkers, the researchers said. But “studies indicate that detection and diagnosis of cognitive impairment or dementia can be increased two- to threefold with routine use of brief cognitive assessments,” they wrote.

The authors highlighted the recent requirement by the Centers for Medicare & Medicaid Services that physicians use cognitive assessments in the Medicare Annual Wellness Visit. They proposed that public health officials add the following approaches in order to increase assessment uptake:

  • Implementing new assessment approaches that do not detract from the physician portion of a visit;
  • Supporting physicians with resources to equip them to more confidently perform and interpret cognitive assessments; and
  • Developing and disseminating culturally appropriate assessment tools for use in diverse populations.

As clinicians and patients wait for more widespread use of biomarkers in the clinical setting, they “share responsibility in recognizing and addressing symptoms of MCI sooner and more proactively,” the authors wrote.

Early intervention allows patients with MCI or MCI due to Alzheimer’s “more time to plan for the future, adopt lifestyle changes that may help slow disease progression, participate in clinical trials and to live more fully, with a higher quality of life, for as long as possible,” they concluded.

The full report can be found on the Alzheimer’s Association website.