A clinical conundrum: Dementia is underdiagnosed, but routine screening is not recommended for patients reporting no concerns

The U.S. Preventive Services Task Force finds there is insufficient evidence to recommend routine screening for dementia in patients who report no cognitive problems. However, this recommendation should not discourage clinicians from exercising vigilance about their patients’ cognitive health. Studies have repeatedly shown that many patients with dementia remain undiagnosed, preventing them and their families from receiving adequate care and support services.

Taking any kind of medication can be a risk for a patient with undiagnosed dementia. Anticholinergic drugs, for example, further suppress the main cell-to-cell communication system disrupted by Alzheimer’s disease. View a list of anticholinergic medications posted by the Geriatrics Department at Virginia Commonwealth University.

To help combat the problem of underdiagnosis, a physician should proactively offer informal cognitive tests to patients when they reach a certain age. For example, it may be advisable to ask patients aged 75 or older if they have noticed any memory problems. Ask their permission to do a quick memory test, and then use the three-word recall, “mini-cog” or coin-counting exercise. If informal testing suggests any problems, discuss the need for a more complete evaluation.

The number of individuals who will develop dementia increases in a fairly linear fashion beginning at age 65. One  study found that Alzheimer’s disease affects older adults at the following rates:

• 3 percent of those age 65 - 74
  
  
• 19 percent of those age 75 - 84
  
  
• 47 percent of those age 85 or older

View the Alzheimer's Research Center website.