Lack of Awareness: Testing for Alzheimer's Disease Unknown to Most Older Adults

A majority of older Americans are unsure about cognitive testing options available to them, according to a new poll.

Although the majority of older adults see the benefit of getting screened for early signs of cognitive decline, a much smaller percentage knows about the full scope of available testing.

Cognitive screening is available in the United States for anyone aged 65 and older who is on Medicare. The screening can be done by primary care doctors during the Annual Wellness Visit (AWV), but the system isn’t perfect; there are no specified tools providers are required to use to screen for cognitive decline.

And, there's always the chance that people don’t get screened at all.

“A lot of times screening for cognitive decline doesn’t happen because such decline is mistaken for normal aging,” Scott Roberts, PhD, co-leader of the research and professor of health behavior and health education at the University of Michigan told Health.

Stigma can make it difficult for people to bring the topic up to their doctors, or they may not think much can be done to help the condition, he added.

Roberts and his team launched the new poll as part of the University of Michigan National Poll on Healthy Aging.

The poll included a national sample of people ages 65 to 80 and found that nearly 30% of people in that group reported being not at all familiar with cognitive decline screening. 30% of people were very familiar with screening options, while approximately 40% were somewhat familiar.

About 40% of people answering the poll reported having had some type of screening.

Some of the people answering the poll—just 19%—were familiar with advanced screening that uses biomarkers in the blood to test for Alzheimer’s disease. Less than 1% had been tested for the biomarkers.

There were also large disparities in who was aware of cognitive testing overall. Compared with non-Hispanic White and Black patients, Hispanic patients in the cohort were less likely to report having undergone cognitive screening within the past year.

The fact that so many had even heard about the test was surprising, said Esther Oh, MD, PhD, co-director of the Johns Hopkins Memory and Alzheimer’s Treatment Center, who was not involved in the research.

There are spinal fluid biomarkers that have been used in the clinical setting for many years, but blood biomarkers are relatively new. Until just a couple of years ago, blood biomarkers for Alzheimer’s disease were exclusively used in research settings, rather than in the doctor’s office.

“I was shocked to see that 20% of people even knew about any kind of blood test because it’s fairly new,” said Oh.

As of now, insurance typically does not cover the tests, nor another auxiliary test called a positron emission tomography (PET) scan, which can detect plaques in the brain that could signal dementia or Alzheimer’s disease.

Because the tests are still new, primary care physicians may need extra training.

“There is a lot of work to be done. We need to provide education for the patients, caregivers, and prescribing doctors who would be administering these tests and interpreting the results,” said Oh. “That’s true for any test.”

It’s also the duty of practitioners working with older adults to be on the lookout for signs of dementia, said Roberts.

He added that some resources, including the Alzheimer’s Association, can help patients and their family, friends, or caregivers better understand what signs and symptoms may be worth bringing up at a doctor’s visit, as well as when they should request screening.

Biomarker tests are only used in some patients, and are not the only test a doctor would use—biomarker tests should never be used as a primary screening tool, since no scan or test is perfect. There is always the chance that the test will reveal a false positive or negative.

A biomarker test can be useful as a follow-up test that can give providers a clearer picture of what’s going on.

“History and a physical exam are the primary way I diagnose cognitive disease,” Oh said. “Then I can get a more complete picture with biomarkers and scans, but it’s important for people to understand that history and physical exam are really important.”

Oh warned that relying on biomarker tests without evaluating the patient and their family history could be a big mistake.

Collecting information from friends or family members who are familiar with the patient is also paramount, she said. This can provide information about changes in the patient’s cognitive abilities that they may not have noticed.

“We also need to figure out, when you take an extra step to do something, what is the outcome you’re hoping to achieve,” said Oh. “If you detect something, what will you do with the information?”

One of the potential interventions would be to discuss with the patient and the care partners about safety, especially if they are living alone or still driving. The second is discussing further treatments.

Although no current treatments can reverse or completely stop Alzheimer’s disease or dementia, Roberts explained that some treatments can slow decline in cognitive function.

An early diagnosis also helps patients and families plan for the future, get connected to education and support programs that can help in coping with the disease. Once diagnosed, eligible patients can also enroll to be part of clinical trials that could lead to future therapies.

New medications can also reverse amyloid beta plaque build-up in the brain, a marker of Alzheimer’s disease. Earlier this year the Food and Drug Administration (FDA) granted accelerated approval for a monoclonal antibody medication that does just that—but the treatment isn’t for everyone.

The side effects of these new therapies include brain swelling and bleeding, said Oh. “It’s not a minimal risk.”