Addressing underlying health issues such as diabetes or insufficient physical activity can play a crucial role in ameliorating mild cognitive impairment. Therefore, it is imperative to engage in open discussions with healthcare professionals about these concerns. A recent study suggests that taking proactive measures and receiving an early diagnosis can potentially delay the onset of dementia.
The study’s findings reveal a startling statistic: over 90% of individuals experiencing mild cognitive impairment are unaware of their condition. This impairment often serves as an initial indicator of Alzheimer’s disease. The research, conducted using data from more than 40 million individuals aged 65 and above covered by Medicare, the U.S. health insurance program, underscores a significant gap in diagnosis. Out of the anticipated eight million cases of mild cognitive impairment, only approximately 8% were documented in health records. The remaining 7.4 million cases were left undiagnosed, highlighting the need for increased awareness and early detection in the realm of cognitive health. These results were published in The Journal of Prevention of Alzheimer’s Disease.
“We expected MCI to be underdiagnosed but not by that much,” lead study author Soeren Mattke, MD, DSc, said. He is also a professor and director of the Center for Improving Chronic Illness Care at the University of Southern California in Los Angeles.
This is likely due to the fact that symptoms such as misplacing car keys or forgetting appointments can be perceived as mild and easily dismissed as a normal aspect of aging, according to Dr. Mattke. Additionally, many clinicians may not give priority to diagnosing these cases, he added.
In another study involving 200,000 Medicare enrollees aged 65 and older, treated across more than 54,000 primary care clinics, it was discovered that 99 percent of doctors were underdiagnosing Mild Cognitive Impairment (MCI). Co-authored by Mattke, this study revealed that only 8 percent of MCI cases receive accurate diagnoses.
“Formally diagnosing these cases takes time, which many clinicians don’t have, and the prevailing perception remains that diagnosing it is inconsequential,” Mattke said. “But with new approved treatments for Alzheimer’s disease, which causes around 50 percent of mild cognitive impairment cases, there is now a sense of urgency to find patients who benefit.”
Recent clinical trials have unveiled two novel medications, lecanemab and donanemab, demonstrating their efficacy in decelerating the progression of Alzheimer’s disease, as highlighted by Mattke. These emerging pharmaceuticals operate by mitigating the buildup of amyloid-beta proteins, known as protein clumps, within the brain—an accumulation believed to contribute to cognitive impairment. Despite their promising potential, a noteworthy challenge associated with these drugs lies in the substantial risk of severe side effects, including the possibility of brain bleeding and swelling.
Lecanemab, marketed as Leqembi, secured provisional approval from the U.S. Food and Drug Administration (FDA)in January, obtaining full clearance by July. On the other hand, donanemab, currently under consideration, anticipates an FDA decision by the year’s end, according to Eli Lilly, the pharmaceutical company behind the drug. It is worth noting that Aducanumab (Adulhelm), another amyloid-targeting drug, gained FDA approval for Alzheimer’s treatment in 2021, sparking debates within the medical community regarding its actual therapeutic benefits for the condition.
Despite the potential advantages of early diagnosis for mild cognitive impairment, Majid Fotuhi, MD, PhD, an adjunct professor and neurologist at George Washington University in Washington, DC, who was not involved in the recent studies, emphasizes the existence of numerous uncertainties regarding the necessity of administering these innovative Alzheimer’s drugs to patients. This underscores the ongoing discourse surrounding the utilization of such medications and their efficacy in addressing Alzheimer’s disease.
“While it is important for physicians to address cognitive decline in the elderly and help them identify the potential causes for such decline, it is also crucial that they do not rush to tell their patients they are one step away from developing Alzheimer’s disease and need to take anti-amyloid medications,” Dr. Fotuhi said.
Individuals diagnosed with mild cognitive impairment (MCI) have the opportunity to enhance their symptoms and outlook by addressing a range of underlying health issues that may adversely affect brain function, according to Fotuhi. Proactive management of conditions such as type 2 diabetes, depression, insomnia, sleep apnea, dehydration, and a sedentary lifestyle can contribute significantly to improved cognitive function in individuals with MCI. By receiving appropriate care for these contributing factors, individuals may experience positive changes in their cognitive abilities, highlighting the interconnected nature of overall health and cognitive well-being.
“People who have been diagnosed with MCI need to have a detailed conversation with their physicians as to what factors may have contributed to their cognitive decline and to make sure all of the following conditions are fully addressed and treated,” Fotuhi said. “Treating these conditions will [improve] their cognitive function and delay the onset of dementia.”
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