Primary care could hold the key to early dementia risk detection

Primary care plays a key role in dementia detection: ©Fengyu - stock.adobe.com

A study from the RAND Corporation found that primary care physicians are positioned for a key role in the early detection, prediction, and management of dementia risk. The research, which analyzed data from over 20,000 older adults in the Health and Retirement Study, could change how health care providers approach patient care for aging populations.

The study identified the predictive power of an individual's health and lifestyle factors up to two decades before dementia onset. This means that primary care physicians have a critical window of opportunity to identify and potentially mitigate dementia risk long before clinical symptoms become apparent.

Lifestyle factors and risk prediction

Researchers identified several key lifestyle factors that significantly increase the probability of developing dementia. Physicians should pay particular attention to patients who exhibit:

• Sedentary behavior and lack of regular exercise
• Obesity
• Minimal engagement in cognitive and social hobbies during their early senior years

“Understanding risk factors can enable health care providers and policymakers to identify groups at the highest risk so they can direct resources to delay cognitive decline or address its effects,”

said Peter Hudomiet, the report’s lead author and a senior economist at RAND, a nonprofit research organization.

The study also uncovered some demographic insights. While Black, Hispanic, and lower-income individuals initially appeared to have higher dementia risks, these factors became statistically insignificant when education and income were controlled. Researchers say this finding underscores the importance of looking beyond surface-level demographic characteristics and focusing on modifiable lifestyle and socioeconomic factors.

The research also found that individuals born in the Southern United States face statistically significantly higher chances of developing dementia, even when accounting for numerous other variables.

Current challenges in cognitive assessment

In current health care practices, only 16% of patients aged 65 or older receive cognitive assessments during routine primary care visits. This low rate of testing represents a significant missed opportunity for early intervention, according to the researchers.

Part of the issue may be the cost of testing.

• 80% of respondents would undergo cognitive assessment if it were free
• Willingness to test drops by nearly 50% if out-of-pocket costs reach $300
• Respondents indicated they would be most compelled to seek clinical care if it would lead to better treatment, with 60% saying they would opt for disease-modifying therapy if it would help maintain independence for an additional three years.

The study found that patients take a proactive approach to potential cognitive decline and its effects on their lives when they are made aware of the risks. Even before receiving a clinical diagnosis, 25% of individuals identified as having potential cognitive issues sought financial assistance, compared to just 2% of those without suspected impairment.

“When people receive a dementia diagnosis, they are more likely to take actions such as establishing a living will or power of attorney or move in with an adult child in order to receive help and reduce financial responsibilities,” said Michael D. Hurd, the study’s lead author and a senior principal economist, in a statement.