Twin Cities doctors tout “Mini-Cog” during physicals as a way to spot Alzheimer’s and related disorders earlier.
John Wagner, 82, worked out questions given by Maria Cofrancesco to assess his condition. His daughter, Lisa Wagner, back, said despite the Alzheimer’s diagnosis, the family is glad for the support and information offered as part of the VA program.
Dr. Michael Rosenbloom says primary-care physicians have a lousy track record of diagnosing Alzheimer’s disease and other forms of dementia.
Now he and his colleagues at the HealthPartners Center for Memory and Aging want to give them a tool that could change that: a quick, pen-and-paper test that, if used during routine annual physicals, could detect cognitive problems in thousands of older patients who may have undetected Alzheimer’s disease or other neurological disorders.
“[If] you’re diagnosing these diseases when these patients are already mistaking their medications, having motor-vehicle accidents, losing their way from home — that’s a failure,” said Rosenbloom, clinical director of the Memory and Aging Center. “We have got to get to these patients earlier.”
More than 5 million Americans older than 65 have been diagnosed with Alzheimer’s disease and other types of dementia. And a recent study suggests that deaths from Alzheimer’s disease have been grossly undercounted — that it may be the third-most-deadly disease in America.
Yet Rosenbloom and other Twin Cities neurologists say that by the time many people have a diagnosis, the disease already has caused serious damage, making intervention and treatment more difficult.
They want primary-care physicians to screen for the disease regardless of whether the patient complains of memory problems.
HealthPartners Care Group, one of Minnesota’s largest medical practices, has been screening Medicare patients ages 70 and older at four of its clinics for more than 18 months. The test, called the Mini-Cog, takes a minute or two and is far more sensitive to mild cognitive impairment than a more-widely-used test developed 45 years ago that takes twice as long.
Among patients who were previously undiagnosed for dementia, 26 percent failed the Mini-Cog and were referred for further evaluation, said Terry Barclay, a neuropsychologist and clinical director at the Center for Memory and Aging.
Failing the test “is associated with a significant increase in emergency-room visits, hospitalizations, phone calls to the clinic … no-show rate and canceled appointments compared to those who pass the screen,” Barclay wrote in an e-mail.
Essentia Health in Duluth has a similar study underway, he said, and the Mini-Cog is also being promoted by Act on Alzheimer’s, a large public-private consortium in Minnesota that advocates for better dementia care.
Many primary-care physicians resist the idea of cognitive screening — worried that failure will lead to the diagnosis of a fatal, largely untreatable disorder, wreck their relationship with the patient and take too much time, Rosenbloom said.
He said doctors often worry that a diagnosis of dementia will cause the patient to become depressed — or worse. But he cited a study that found anxiety and depression either remain stable or decrease after diagnosis. Rosenbloom said in his experience, people often are relieved to learn the diagnosis and the disease can be managed with lifestyle changes.
“You take a huge weight off their shoulders, and their quality of life improves significantly,” he said.
In addition, Rosenbloom said, about 9 percent of dementia cases result from treatable causes such as vitamin B12 deficiency, thyroid disease, depression or heavy-metals toxicity.
Barclay called routine cognitive screens “the gold standard” of care and said if patients and their families knew that, they wouldn’t settle for less. “And if providers understand what the gold standard is, they won’t provide anything less,” he said.
HealthPartners is evaluating the potential risks and benefits of conducting cognitive screening systemwide in what it calls its “Sixth Vital Sign” project.
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