​​Dementia is staggeringly common, with an overall prevalence of 11 percent in people ag​ed 65 and over​. This prevalence increases markedly with age, such that it affects over half of octogenarians and one in three will ultimately die in this condition. These statistics do not include mild cognitive impairment (MCI), mental changes that are measurable but not severe enough to affect daily function and are often but not always a precursor to dementia, or subjective cognitive decline, self-reported mental fogginess or memory depreciation that aren't able to be measured by a test.

Detecting and Diagnosing Dementia

Despite being widespread, official diagnosis lags behind the true prevalence, with only 3-4 percent​ of patients having “dementia" (let alone Alzheimer's disease or a specific type of dementia) written anywhere in their chart. This amounts to more than 3 million Americans lacking a diagnosis, a number which will double in the next decades if diagnosing doesn't catch up.

The early stages of dementia, particularly Alzheimer's disease, which most commonly manifests with short-term memory loss and difficulty navigating an environment, is not always obvious from a short interaction. Verbal abilities can be intact, and a patient can regale you with stories from their youth, masking the fact that when they are sent home from the doctor's office with instructions to take a medication once a day, they may not fully understand, remember, or have the capacity to follow instructions. Caring family members such as adu​​lt children living out of state may also take a long time to go from a subtle feeling or suspicion that something seems off or odd to the conclusion that there may be a real problem. This can obviously have catastrophic consequences—preventable adverse events and hospitalizations; missing the opportunity to reverse, slow, and mitigate disease; and treatment for symptoms that can improve quality of life and functional independence.

Improving detection and arriving at diagnosis before the onset of catastrophic events, more severe disease, and unmanageable symptoms begins with equipping clinicians on the front lines with validated tools to assess function rapidly, reliably, and comprehensively across cognitive domains. Tools must be simple enough for the non-specialist to gain comfort with and fit reasonably within their established workflows. For example, a recent peer-reviewed study in the Journal of Medical Internet Research (JMIR) Aging validates the efficacy of a computerized cognitive test. Conducted in-person or remotely, this type of assessment improves accessibility to testing while providing physicians with the tools necessary to diagnose and treat patients.

To better detect and diagnose dementia, physicians must go beyond patient interviews (i.e. do you feel like you are losing your memory?) and use formal assessment tools, looping in a specialist for complex cases when needed. If MCI is identified, the physician must further assess for functional impairment to arrive at a diagnosis of dementia and perform serial assessments for changes in cognitive status (improvement or decline) that could change diagnosis and management approach.

Preventing Adverse Events and Hospitalizations

People with dementia have much higher hospitalization rates than older adults without. According to a recent study, 40 percent of hospitalizations in the dementia cohort could have been preventable with proper identification, education, and outpatient care. When care teams are on the same page about a person's cognitive status, the individual can be given additional supervision or support to prevent adverse events. Consistency between caregivers is essential toward preventing trips to the hospital as well as reducing uncertainty and conflict around patient care and well-being.

Ruling Out and Addressing Reversible Causes

Cognitive impairment does not always spell dementia. Many cases of MCI are due to reversible causes, with the most common offenders being medication adverse events, depression, sleep apnea, infection, and thyroid disease. Long COVID is another major driver, with more than 70 percent​ of sufferers calling out brain fog as a chief complaint.

It is for this reason that the American Academy of Neurology cites ruling out and addressing reversible causes as a primary reason for performing cognitive assessment. Clinicians should perform a medical evaluation of common reversible causes.

Addressing Risk Factors to Slow Progression

The landmark FINGER study and subsequent World-Wide FINGERS network found that 40 percent of dementia is preventable by addressing certain modifiable risk factors. These include:

1. high blood pressure,
2. smoking,
3. diabetes,
4. obesity,
5. physical inactivity,
6. poor diet,
7. high alcohol consumption,
8. low cognitive engagement,
9. depression,
10. traumatic brain injury,
11. hearing loss,
12. social isolation, and
13. air pollution.

The physician is charged with the task of working with the patient and caregivers to put together a comprehensive cognitive care plan that addresses these modifiable factors in a holistic manner. By giving them the knowledge, resources, and motivation to see the patient through the long journey of cognitive change, they can slow dementia's progression and give the patient a better prognosis.

There are now few pharmaceutical options to treat dementia, with cholinesterase inhibitors showing efficacy in dementia's early stages. There are multiple medications at different stages of the drug development pipeline, and all of them depend on patients being identified as early as possible to have the best chance of success.

Behavioral and psychiatric symptoms are common in dementia, and an early and specific diagnosis enables clinicians to treat these with the best approaches available.

Yael Katz, Ph.D.,​​ is co-founder and CEO of BrainCheck. Katz received her Ph.D. in neuroscience from Northwestern University and conducted her postdoctoral work at Princeton University.​