Adults, Doctors in US Struggle to Tie Cognitive Problems to Alzheimer’s

Marisa Wexler MS avatar

by Marisa Wexler MS |

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Most adults in the U.S., as well as many doctors, have difficulty distinguishing between the early stages of Alzheimer’s disease and cognitive changes due to normal aging, according to the latest annual report from the Alzheimer’s Association.

The report draws on responses to surveys, one of adult Americans and another of primary care physicians in the U.S., conducted by the association in late 2021.

Mild cognitive impairment, or MCI, is characterized by subtle changes in thinking and memory that do not substantially interfere with day-to-day life, but are nonetheless noticeable to the person and those around them.

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MCI is estimated to affect about 12% to 18% of adults over age 60, and is distinct from the forgetfulness or confusion that can accompany normal aging. When a person has MCI and biological evidence of brain changes typically associated with Alzheimer’s, they are said to have MCI due to Alzheimer’s disease.

Some people with MCI may find their symptoms resolve with time, but more than 1 in 10 MCI patients progress to develop full-blown dementia every year, and about 1 in 3 people with MCI develop dementia due to Alzheimer’s disease within five years of first experiencing MCI symptoms, the association noted.

According to the report, more than 80% of the 2,434 adults who answered the survey are not familiar with MCI. These rates were similar across racial and ethnic groups. When prompted with a description of the condition, more than half (55%) said that MCI sounded similar to “normal” aging.

“Mild cognitive impairment is often confused with ‘normal aging,’ but is not part of the typical aging process,” Maria Carrillo, PhD, chief science officer of the Alzheimer’s Association, said in a press release.

Less than half (40%) of respondents planned to see a doctor promptly if they started to experience MCI symptoms — while 60% either said they would wait or not seek medical care at all. Concerns about seeking care included fears of an incorrect diagnosis, learning of a serious problem, fear of unnecessary treatments, or a belief that symptoms will resolve in time.

Distinguishing between MCI and typical aging “is critical in helping individuals, their families and physicians prepare for future treatment and care,” Carrillo said.

Additional findings from the 801 primary care physicians (PCPs) surveyed showed that most (75%) believed that they are the front line for discussing MCI with the general public — but markedly fewer said they felt comfortable answering patient questions about MCI (65%) and/or talking about how MCI is connected to Alzheimer’s (60%).

Even though 90% of PCPs agreed that having a specific MCI diagnosis can be helpful in giving patients optimal care, more than three-quarters of these doctors (77%) said that MCI due to Alzheimer’s is hard to diagnose, and just over half (51%) do not usually feel comfortable diagnosing the condition.

“Understanding and recognizing mild cognitive impairment due to Alzheimer’s disease is important because it provides an earlier opportunity to intervene in the Alzheimer’s disease continuum,” Carrillo said. “While currently there is no cure for Alzheimer’s disease, intervening earlier offers an opportunity to better manage the disease and to potentially slow progression during a time when individuals are functioning independently and maintaining a good quality of life.”

A majority of adult survey respondents (85%) said that they would want to know if they had Alzheimer’s in the earliest stages, either during MCI or the early stages of Alzheimer’s dementia. Of these adults, over two-thirds (70%) noted that an early diagnosis allows a family to make important choices about future finances, legalities, and medical care in a way that is consistent with the patient’s desires.

Access to potential treatments also was noted as an important reason for wanting an early diagnosis, and most of the PCPs (86%) said that an early diagnosis and treatment could help slow the decline in cognition. However, 80% of the PCPs were not familiar with clinical trials available to MCI patients, and less than 1 in 4 (23%) said that they are familiar with potential therapies being developed to treat MCI due to Alzheimer’s disease.

When MCI is detected, most doctors said they recommend lifestyle changes (73%), laboratory tests to look for potentially treatable causes (70%), and/or refer patients to a specialist (53%).

“There is more work to be done when it comes to expanding primary care physicians’ readiness to diagnose cognitive impairment, including MCI and MCI due to Alzheimer’s disease, particularly as diagnostic advancements are being made,” said Morgan Daven, vice president of health systems at the Alzheimer’s Association.

“This includes primary care physicians’ awareness of new potential treatments and patient participation in Alzheimer’s disease-related clinical trials and research,” Daven said.