MARY LOUISE KELLY, HOST:
Primary care doctors are really good at checking seniors for problems like high cholesterol, high blood pressure, but as NPR's Jon Hamilton reports, these doctors often fail to test their older patients for signs of dementia.
JON HAMILTON, BYLINE: A report by the Alzheimer's Association found that only about half of primary care doctors say they routinely test patients 65 and older for problems with memory and thinking. Keith Fargo of the Alzheimer's Association says that figure is distressingly low.
KEITH FARGO: This cognitive assessment should be part of every senior's annual wellness visit, but we're seeing that it's simply not happening.
HAMILTON: Even though Medicare covers the test. Fargo says the result is that many seniors are diagnosed with Alzheimer's too late to plan for the future or enter a clinical trial.
FARGO: The first person who gets a drug that stops their Alzheimer's disease will get that drug in the context of a clinical trial. And that's only going to happen to someone who knows that they have cognitive decline.
HAMILTON: The report found that 82 percent of seniors think it's important to have their thinking and memory checked out regularly. But Joanne Pike of the Alzheimer's Association says that many doctors are hesitant to suggest a cognitive test, which takes a few minutes.
JOANNE PIKE: Usually, what we're seeing is that physicians are waiting for the senior to bring any concerns to them.
HAMILTON: And Pike says seniors rarely do that.
PIKE: Some of it could be fear, some of it could be stigma, and some of it could be a little bit of, unfortunately, people believe that there's not a benefit to knowing about the disease or dementia.
HAMILTON: Some doctors fear their older patients may be harmed by learning they have a cognitive problem. So a team including Nicole Fowler of Indiana University School of Medicine did a study to find out.
NICOLE FOWLER: And what we found actually in that study is that there wasn't any harm, so there was no increase in rates of depression or anxiety in older adults who were screened.
HAMILTON: Fowler says the challenge is making sure seniors get the right care and counseling after a cognitive test suggests a problem.
FOWLER: We remind them this is just a screening test. This is by no means a diagnosis.
HAMILTON: Fowler says even so, about half refuse further evaluation. So she says the medical system needs to do a better job staying in touch with people who've been screened.
FOWLER: We would never screen for a cancer, you know, send somebody for a mammogram and then never follow up with them.
HAMILTON: Some primary care doctors say they don't do routine screening because studies haven't shown a clear benefit. Dr. Sheryl Sun is chief of internal medicine at Kaiser Permanente in Santa Clara, Calif. She says screening patients who appear fine takes up valuable time.
SHERYL SUN: And if you spend time doing things of questionable value, you might not get to the things that are of proven value.
HAMILTON: Like screening for diabetes. Sun also says primary doctors who know their patients well don't need formal tests to detect cognitive problems.
SUN: We will notice a change, you know, within a few minutes of walking in the exam room.
HAMILTON: Sun says cognitive tests will become routine when researchers develop an effective treatment for Alzheimer's. Jon Hamilton, NPR News.
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