How GPs can forestall their patients’ cognitive decline

Early detection with modern tools is necessary to improve the quality of life of your patients

In less than 15 years, the US population of people aged 65 and over is expected to grow to 80 million, according to US Census projections, from under 55 million in 2019. Unfortunately, years of life gained are often associated with disability due to health. As part of the UN Decade of Healthy aging (2021-2030) there is a global impetus for funding healthy aging and give life to years.

Neurological diseases such as stroke, Parkinson’s disease and dementia are the most common cause of disability worldwide. The WHO projects that by 2030, brain-related disabilities will account for half of the global economic impact of disability. Dementia is the disability most feared by adults in the United States, and Alzheimer’s disease is the most common type of dementia. According to the Alzheimer’s Association, more than 10% of people aged 65 and over and about a third of people aged 80 and over currently have Alzheimer’s disease. Boosting brain health is crucial to add life to years.

Unfortunately, the current state of brain care offers too little, too late, and fails to promote brain health and prevent or minimize the effects of brain-related disabilities. To improve care and meet growing needs, the following challenges need to be addressed:

The current approach to brain health is largely reactive, with minimal attention paid to preventing cognitive decline and promoting cognitive resilience. Treatment of the brain typically only becomes a priority when a patient or family member raises a concern, delaying diagnosis and shortening the window for intervention, particularly given patients’ reluctance to raise concerns (e.g., due to of stigma). The heart health or cancer prevention approach illustrates the power and promise of a different, more proactive approach to brain health.

Primary care providers (PCPs) face practical obstacles when it comes to performing more routine screening.A recently Alzheimer Society Survey found that almost all GPs (96%) think it is important to screen patients aged 60 and over for cognitive impairment, but they are currently doing screening for half (48%). Among the key barriers, 72% of PCPs reported difficulty distinguishing pathological cognitive impairment from normal aging, and 47% said they lacked the expertise to conduct cognitive assessments. PCPs also report a lack of access to cognitive testing, as well as the resources and time to administer it. Overall, GPs are currently not well equipped to screen and monitor patients for cognitive impairment.

Limited access to specialized resources for specific diagnoses leads to delays in initiating treatment plans. Unfortunately, there is a significant shortage of skilled workers, which often leads to waiting times of three to nine months. Many patients may not need a referral if GPs were better equipped to provide diagnostic and treatment services, particularly for patients with uncomplicated cases of dementia and other brain disorders.

The early detection of cognitive impairment and a specific diagnosis, e.g. B. Mild Cognitive Impairment (MCI), offers several opportunities that benefit individuals and their families:

Effects of lifestyle and health-related interventions on cognitive development. Research shows that maintaining brain function and building cognitive resilience is a lifelong endeavor. Increasing evidence also suggests that interventions for modifiable risk factors such as obesity, hearing and/or visual impairment, nicotine use, elevated blood pressure, high cholesterol, mood disorders, drug side effects, poor diet, sleep disorders, lack of exercise and/or loneliness may help Reduce the risk of cognitive impairment and dementia progression (see Lancet Commission 2020, FINGER study 2015). Fortunately, in a 2022 Lifebrain survey, 70% of respondents said memory issues were a key motivator for them to improve their lifestyle (with the guidance of their care team). These results underscore the need for a greater emphasis on prevention and implementation of personalized interventions as early as possible.

Plan for what matters most. Early diagnosis empowers patients and their families to define and plan for their future goals (ie, live the life they choose based on what matters most to them). A poll by the Alzheimer’s Association found that 85% of older adults in the US would want to know early if they have Alzheimer’s, citing their top two reasons for having the ability to plan with their families and for earlier treatment (both 70%).

Get timely care and access to clinical trials. A clear and early diagnosis helps ensure that therapies can be implemented much earlier, in windows of opportunity where the greatest improvements are possible. It also gives patients time to consider enrollment in clinical trials and allows researchers to follow them longitudinally and develop objective metrics for target engagement for novel treatments.

PCPs are well positioned to work with individuals and their families to promote brain health, identify cognitive impairment early and ensure interventions are targeted to what matters most to each patient. For this, PCPs need new tools. Fortunately, the landscape of cognitive assessments is rapidly evolving as technology advances, technology adoption increases among older adults, and external events — such as the COVID-19 pandemic — drive innovation.

There are several limitations to traditional cognitive screening tools. Paper-based assessments require manual workflows, involve subjective assessments and interpretations, and provide limited insight into an individual’s cognitive abilities, making them neither efficient nor scalable. In addition, larger neuropsychological batteries are required for confirmatory diagnosis, and the process of performing these tests and obtaining results can be time- and labor-intensive, thus causing unnecessary delays in clinical decision-making.

Digital cognitive assessments open up a new space for proactive screening and interventions in primary care. AI-powered assessments that measure performance across a range of tasks and analyze a wide range of metrics offer the potential for early detection and specific diagnosis to detect subtle signs of cognitive impairment preclinical AD and MCI subtypes. These tools are also much more efficient, easily integrated into primary care workflows, and may not require physician administration. Automated scoring and instant interpretation give GPs additional time to focus on next steps for the patient, which some digital solutions also support with built-in clinical decision support.

Wider use of digitally supported cognitive assessments can benefit patients, providers and the entire healthcare system. Digital solutions bring value to GPs by improving both cognitive assessment rates and in-office workflows, while providing new revenue opportunities. They can be efficiently embedded into annual well visits, establishing reliable practice for cognitive screening, and they can help primary care physicians take advantage of Medicare’s new reimbursement codes for cognitive assessment and care planningwho have been underutilized to date. Additionally, in a value-based world of healthcare, streamlined assessments offer the potential to prevent complications that require urgent or acute care by identifying those at highest risk early. By enabling broader and more efficient screening, digital assessments can help enable earlier and more impactful interventions, more effective triage of specialists, and opportunities for patients to participate in clinical trials.

It is never too early, but never too late to influence individual cognitive pathways and reduce patients’ risk of brain-related disability and dementia. Gaining a deeper understanding of novel approaches to digitally assessing brain health may empower primary care physicians to help their patients stay ahead of cognitive decline and transform human health.

Alvaro Pascual-Leone, MD, PhD is Linus Health’s Chief Medical Officer, Professor of Neurology at Harvard Medical School, Principal Investigator at the Hinda and Arthur Marcus Institute for Aging Research, and Medical Director of the Deanna and Sidney Wolk Center for Memory Health at Hebrew SeniorLife .

Ankur Bharija, MD is the vice president of geriatrics at Linus Health and is an assistant professor and practicing geriatrician, primary care and population health at Stanford University School of Medicine.

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