Many people with dementia don't realize they have the disease until it's at an advanced stage, when everyone can tell something is wrong. Other people might start forgetting dates or names and worry they have dementia, yet their memory problems are just a normal consequence of aging. Having primary care doctors routinely screen patients for dementia at annual check up visits—just like they do for high blood pressure or cholesterol—could identify people in need of dementia care and reassure those who are healthy. That's what dementia experts argued at a meeting held last month in New York City, as reported on Alzforum (www.alzforum.org).
The meeting was co-sponsored by the Alzheimer's Foundation of America (AFA) and the Alzheimer's Drug Discovery Foundation (ADDF). The two organizations intend to issue joint recommendations on how to increase dementia detection in primary care practice. The Patient Protection and Affordable Care Act signed into law in 2010 calls for Medicare to start in 2011 to pay for an annual wellness visit that includes the detection of any cognitive impairment—that means, any disorder in which thinking (cognitive) abilities are reduced, including dementia.
One argument against this coming prospect is that there isn't much doctors can do for people who test positive for cognitive impairment or dementia. But participants at the AFA-ADDF meeting argued there is some evidence that knowing if someone has dementia helps doctors provide better overall medical care. On the other hand, it will be challenging to add dementia screening and follow-up to an already crowded primary care system. There are many tests that doctors can use to detect dementia, and they do so reliably. Even so, a large proportion of patients who screen positive on those tests do not return for further follow-up.
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