According to a new RAND report, the risk of developing dementia later in life is strongly predicted by a person’s cognitive abilities, functional limitations and physical health, as much as 20 years before the onset of the disease.
Related new research has found that early detection of cognitive impairment helps people take mitigation measures to prepare for future loss of financial and physical independence.
Although acceptance of cognitive testing among older adults is currently low, additional research has shown that the use of cognitive testing would increase if it were free and easily accessible, and with the development of improved treatments.
Early detection of Alzheimer’s disease and related dementias among the 58 million Americans over age 65 is critical, in part because available disease-modifying treatments only work for patients with early-stage disease. Only about 16% of people aged 65 or over undergo such an assessment during a routine visit to their GP.
RAND researchers conducted three studies to understand who is most at risk for developing cognitive impairment, how to increase uptake of cognitive testing among older adults, and how to encourage at-risk patients to continue caring for brain health received.
The first study used data from cognition and dementia measures in the Health and Retirement Study to detect an increased risk of dementia years before its onset. The survey is a nationally representative sample of approximately 20,000 older adults and their households in the US and has been ongoing since 1992.
Lifestyle factors such as a lack of exercise, obesity and not pursuing hobbies at age 60 were predictors of who would develop dementia, according to the analysis which examined 181 potential risk factors to see which were most associated with developing dementia.
In addition to lifestyle factors, researchers found regional associations with dementia. People born in the South have statistically significantly higher odds of developing dementia, even when many other factors are controlled for.
Although black, Hispanic, and lower-income people had a higher risk of developing dementia, race and ethnicity were not risk factors after controlling for education and income. Parental health, family size, and marital history were not strong predictors of dementia.
“This work provides additional evidence about the actions individuals can take to pursue lifestyles that promote brain health across the lifespan,” said Peter Hudomiet, lead author of the report and senior economist at RAND, a non-profit -profit research organization. “Understanding risk factors can allow healthcare providers and policy makers to identify groups at highest risk so they can target resources to slow cognitive decline or address its effects.”
To better understand what people do when they know about possible cognitive decline, a second study examined the relationship between individuals’ cognitive status, the mitigation measures they took to prepare for the consequences of cognitive decline, and how they subsequently fared. This analysis also used information from the Health and Retirement Study.
Researchers found that individuals newly diagnosed with dementia were more likely to take action: 25% sought help with their children’s finances, compared to just 2% of respondents without a diagnosis.
Even before receiving a medical diagnosis, people identified by surveys as having dementia were much more likely to receive help with finances: 29% versus 2% among those without dementia. This finding suggests that many people realize they have a cognitive problem and take action before the clinical diagnosis is made.
“When people are diagnosed with dementia, they are more likely to take action, such as creating a living will or power of attorney, or moving in with an adult child to get help and reduce financial responsibilities,” says Michael D. Hurd , the study’s lead author and a senior chief economist.
In a third study, researchers surveyed a representative sample of Americans using the RAND American Life Panel and found that out-of-pocket costs were the strongest barrier to seeking cognitive assessments, follow-up appointments, and dementia treatments.
If testing were free, 80% of respondents said they would undergo a cognitive assessment and 77% would take an early detection test for Alzheimer’s disease. However, when tests cost $300, the number of people willing to get tested fell by about half.
Respondents indicated that they would be most likely to seek clinical care if it led to better treatment. About 60% said they would choose a disease-modifying therapy if it would help them maintain their independence for another three years.
Broadening the use of cognitive assessments is an important strategy to identify patients who may benefit from current and future treatments for Alzheimer’s disease and related dementias. Assessments provided individuals with information that can facilitate actions to prepare for the future.”
Susann Rohwedder, lead author of the third report and senior economist at RAND
Support for the research was provided by Genentech.