What did older adults do with their dementia screening results?

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Alzheimer’s disease and related dementias (ADRD) and mild cognitive impairment (MCI) are often under-recognized in the community. Screening could offer benefits including early treatment, research participation, lifestyle modification, and advance care planning. However, there are no clear guidelines on the benefits versus harms of dementia screening or whether a screening program could succeed.

A community-based study evaluated an MCI/ADRD screening program and what older adults would do with the information. Researchers collected measures of cognition, physical health, functionality, and mood. Participants met with a health professional, received their screening results and recommendations, and were contacted 60 days later about what they had done with the results. Logistic regression models were used to build predictive models.

The 288 participants had a mean age of 71.5±8.3 years and mean education of 13.3±4.8 years; 70% were female, 67% White, 26% African American, and 48% Hispanic. After 60 days, 75% were re-contacted; 54% shared results with family, 33% with health care providers (HCPs), and 52% initiated a behavioral change. Among participants who shared results with HCPs, 51% reported that HCPs did not follow up on the results, and 18% reported that HCPs showed no interest in the screening visit or its results.

Predictors of sharing results with HCPs were elevated hemoglobin A1C (OR 1.85; 95% CI 1.19–2.88), uncontrolled hypertension (OR 2.73; 95% CI 1.09–6.83), and mobility issues (OR 2.43; 95% CI 1.93–5.54). Reported behavioral changes included lifestyle modification (58%), social engagement (10%), cognitive stimulation (5%), and advance care planning (4%). The most significant predictors of sharing with family were better overall mental health (OR 0.19; 95% CI 0.06–0.59) and better physical function (OR 0.38; 95% CI 0.17–0.81).

The researchers said screening was well-received by the diverse community sample. Participants showed interest in sharing results with family and HCPs, and many attempted behavioral change. HCPs did not always act on results, but 25% ordered further testing and evaluation. The researchers called for efforts to increase older adults’ self-efficacy in discussing results with HCPs and to educate HCPs about the value of early MCI/ADRD detection. They concluded that community dementia screening programs can increase MCI/ADRD detection and improve patient-centered outcomes and medical decision-making.