The delayed diagnosis of dementia carries profound consequences. Without prompt and accurate identification, individuals suffering from undiagnosed cognitive impairments face a myriad of risks, including medication discrepancies, falls, and escalated caregiver burden. Furthermore, such delays restrict access to vital resources and care services that could notably enhance their life quality.
A pioneering study conducted by Emory University School of Medicine in collaboration with Indiana University has uncovered a significant prevalence of undiagnosed cognitive impairments among older adults attending primary care at federally qualified health centers (FQHCs). These centres primarily cater to underprivileged groups, where findings particularly pointed out that African American patients had a higher likelihood — more than double that of their white counterparts — of having their cognitive issues go unnoticed. This research underscores a pivotal lack of early detection in marginalised communities that are inadequately served.
“Unrecognised cognitive impairments, including dementia, pose a formidable challenge both in the U.S. and globally, affecting not only patients but their families and the broader health care infrastructure,” remarked Ambar Kulshreshtha, MD, an associate professor at Emory University School of Medicine and the lead researcher of the study. He stressed that the ramifications of late diagnoses are severe, often resulting in the identification of patients at more advanced stages where symptoms have worsened, and medical care becomes substantially more complex. Early diagnosis is crucial as it opens the door to treatment options that can slow the progression of the disease.
Regarding the impact on underserved communities, FQHCs serve as a critical healthcare resource for approximately 30 million patients in the U.S., most of whom live below 200% of the federal poverty level. This makes it challenging for them to afford specialised medical services typically covered by private insurance or require out-of-pocket expenses. Published in the JAMA Open Network, the study involved a detailed examination of 204 adults aged 65 and older from five FQHCs in Indianapolis between 2021 and 2023 who had no prior memory impairment diagnosis. Through a rigorous process including interviews, medical reviews, neurological exams, and neuropsychological tests, the interdisciplinary team diagnosed each participant with either normal cognition, mild cognitive impairment (MCI), or dementia. It was found that 75% of participants had undiagnosed mental issues, with 62% displaying MCI and 12.3% confirmed to have dementia.
The findings also shed light on significant racial disparities, with African Americans experiencing undiagnosed cognitive issues at more than double the rate of whites. This disparity persisted even after adjusting for variables such as age, gender, and educational level, emphasising the urgent need for improved early detection pathways in these vulnerable populations. The study suggests that higher rates of cognitive issues among African Americans are influenced more by social determinants like residential segregation, environmental pollution, racial discrimination, and disparities in education rather than biological differences.
The systemic issues, including limited time for screenings, inadequate training, and insufficient resources, exacerbate the problem of undetected cognitive impairments in African American communities. Kulshreshtha advocates for the removal of barriers to dementia screening, emphasising the necessity for timely screenings, especially among high-risk groups. He highlights the challenges faced by other minorities, such as those who do not speak English or live in rural areas, and the pervasive stigma and misconceptions surrounding dementia that need to be addressed through community education and healthcare system reform.
To facilitate early detection, experts recommend incorporating brief cognitive assessments during routine medical visits, which can serve as a practical approach to recognising early signs of dementia. In Atlanta, Dr. Kulshreshtha contributes to addressing this issue through his involvement with Georgia Memory Net, a state-funded initiative led by Emory that aims to promote early and accurate diagnosis of Alzheimer’s through primary care settings.
Moreover, recent advancements in dementia care have been exemplified by the introduction of the Centers for Medicare & Medicaid Services’ (CMS) new payment model, the Guiding an Improved Dementia Experience (GUIDE). This model, operational since July 2024 at Emory Integrated Memory Care in Atlanta—one of the nation’s leading nurse-practitioner-led primary care practices for dementia patients—aims to enhance care delivery and alleviate pressure on unpaid caregivers. Dr. Kulshreshtha’s dedication to improving dementia care is evident through his research and his active engagement in developing practical solutions to the challenges faced by patients and their families, as praised by Ted Johnson, MD, at Emory.
More information: Ambar Kulshreshtha et al, Prevalence of Unrecognized Cognitive Impairment in Federally Qualified Health Centers, JAMA Network Open. DOI: 10.1001/jamanetworkopen.2024.40411
Journal information: JAMA Network Open Provided by Emory Health Sciences
