Screening for Alzheimer's Disease in Primary Care Practice

Introduction: Alzheimer's Disease (AD) is a progressive dementia that affects approximately 5.3 million Americans and is the sixth leading cause of death in the US. As of 2010, 11,000 Vermonters have AD. The Centers for Medicare and Medicaid Services recently included detection of cognitive impairment in the new Annual Wellness Visit rules. In light of these recommendations, the goal of the project was to ascertain physician attitudes and practices toward screening and early detection of AD. Methods: An anonymous multiple-choice electronic survey was distributed to 280 primary care physicians (PCPs) throughout Vermont; 63 surveys were completed. In addition, patients with dementia and their caregivers were invited to attend a focus group; 13 participants provided perspectives on the diagnosis of dementia and shared their personal experiences. Results: While 87% of physicians believe screening for AD is not important because there is no effective treatment, focus group participants consider a diagnosis essential for making plans, learning about their disease and establishing a “new normal.” While the most common reason that physicians don't always screen for dementia is because other medical issues are more pressing, focus group participants stated that cognitive status should be addressed in every encounter because it's an everyday struggle. Conclusion: We encourage PCPs to proactively screen for dementia, ultimately so that patients can maintain quality of life prior to the onset of late-stage disease. From our interactions with patients with dementia and their families, we learned that the diagnosis itself facilitates accepting and adapting to life with cognitive decline.