Early Detection and Diagnosis
Early detection, a core public health strategy, is essential to providing access to information, care and support to people living with Alzheimer's and other dementia. Many people living with Alzheimer's are not diagnosed. Even among those who are, a large number are unaware of their diagnosis. An early diagnosis, though, can improve the quality of care and quality of life and may reduce the financial and emotional impact of the disease.
For an overview of these issues, and other related topics:
- Early Detection and Diagnosis of Alzheimer's Fact Sheet (PDF).
- Ensuring Early Detection and Diagnosis Issue Map (PDF).
Learn how public health can advance early detection and diagnosis by educating the public and health care providers.
Educating the public
Individuals must feel comfortable discussing concerns about their thinking and memory with their health care providers. This requires addressing barriers to such conversations. Barriers include not knowing the warning signs of cognitive impairment, misperceptions about Alzheimer's and other dementias, and community and family stigma associated with an Alzheimer's diagnosis.
What public health can do
Public health agencies can educate people of all ages about cognitive health, the benefits of early detection, and when to discuss concerns with a health care provider. Specifically, these public awareness efforts should target:
- Awareness about cognitive health and changes in thinking or memory that call for a conversation with a health care professional.
- Shifting mindsets and normalizing discussions about cognitive health in routine health care.
- The advantages of receiving a formal diagnosis, including access to treatments that help with symptoms, time to build a care team, and the opportunity to specify care and legal plans for the future.
- Reducing stigma and myths surrounding Alzheimer's and other dementias.
State success: Educating the public in Georgia
The Georgia Department of Public Health developed and conducted a public awareness campaign — Think About It. The campaign educated the public about cognitive health, encouraged individuals experiencing cognitive concerns to talk to a health care provider, and provided tools for clinicians to identify warning signs and how to utilize the cognitive health benefit of Medicare's Annual Wellness Visit. The campaign was promoted through public transit ads.
Educating health care providers
While the benefits of early detection are numerous and well-established, clinicians face obstacles that hinder early detection and diagnosis. Barriers include:
- Lack of education on the signs of cognitive impairment.
- Limited education or training on dementia care.
- Concerns about stigma and the usefulness of an early diagnosis.
- Confusing cognitive impairment with conditions that may mimic dementia (including delirium, certain vitamin deficiencies and depression).
- Lack of time.
- Difficulty talking about dementia or disclosing a diagnosis.
What public health can do
Health care providers often turn to public health agencies for help understanding the latest research, best practices and emerging evidence on a number of health topics — including cognitive impairment and dementia. Public health officials can ensure that health care providers stay current with necessary education and training needed to properly assess cognitive impairment and compassionately disclose a diagnosis. Important areas for provider education include:
- Early detection, diagnosis, documentation of diagnosis, disclosure of diagnoses, and care of dementia.
- The Medicare Annual Wellness Visit's cognitive assessment provisions, reimbursement for comprehensive care planning (via CPT® code 99483), and the availability of community services and support after a diagnosis.
- Tools and resources available to help providers detect and diagnose cognitive impairment as early as possible. Resources include:
- The KAER Approach to Cognitive Impairment toolkit developed by the Gerontological Society of America.
- Online training by the Health Resources and Services Administration about Alzheimer's disease, provider education and dementia caregiving.
- Disparities in risk for and diagnoses of cognitive impairment and of appropriate clinical monitoring among some populations.
Learn more with additional early detection and diagnosis resources, including:
- Issue Brief on Early Detection and Diagnosis of Alzheimer's (PDF).
- 10 Early Signs of Alzheimer's.
- Medicare Annual Wellness Visit Fact Sheet (PDF).
- Earlier Diagnosis.
- Information for Health Systems and Clinicians.
- Diagnosing Alzheimer's: The Case for Public Health Action (Webinar).
State successes: Educating health care providers in Hawaii and California
The Hawaii Director of Health sent a “Dear Colleague” letter (PDF) to physicians encouraging early detection and diagnosis, including through the use of the Medicare Annual Wellness Visit benefit.
The California Department of Public Health (CDPH) created the Assessment of Cognitive Complaints for for Alzheimer's Disease (ACCT-AD) to provide primary care providers with the tools and training necessary to recognize normal cognition, diagnose Alzheimer's disease, and identify other cognitive problems requiring speciality referral. CDPH promotes the toolkit to providers statewide, including webinars on the importance of the toolkit and what it aims to accomplish.