More people are dying from dementia, and location and demographics are among the factors that may contribute to not only a dementia diagnosis, but also to how quickly someone will experience cognitive decline, according to a trio of recently published studies.
Location matters
Location matters when it comes to an Alzheimer’s and related dementia diagnosis opening access to the latest treatments, according to a new study from the University of Michigan.
In a study, published today in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, researchers found wide regional variations in the percentage of people who receive a new dementia diagnosis each year. And the difference was even greater for people on the young end of the dementia-risk age range — ages 66 to 74 — as well as for Blacks and Hispanics.
The findings, according to the authors, suggest that the chance of receiving a diagnosis may have more to do with the health system than about individual factors that affect dementia risk. The investigators said that their study, for the first time, shows that regional diagnosis differences are not tied to differences in dementia risk levels.
“These findings go beyond demographic and population-level differences in risk, and indicate that there are health system-level differences that could be targeted and remediated,” lead author Julie Bynum, MD, MPH, a U-M Health geriatrician, said in a news release. “The message is clear: from place to place the likelihood of getting your dementia diagnosed varies, and that may happen because of everything from practice norms for healthcare providers to individual patients’ knowledge and care-seeking behavior.”
Bynum and colleagues at U-M and the Dartmouth College Geisel School of Medicine used data from the records of 4.8 million Medicare beneficiaries who were 66 and older in 2019. The researchers found that the prevalence of diagnosed dementia ranged from 4% to 14% depending on the hospital referral region, and the rate of new dementia diagnoses in 2019 ranged from 1.7% to 5.4%.
Researchers said that those regional variations could be attributed to differing clinical practices for screening or the availability of specialists, or cultural or personal differences in seeking care.
Although dementia has been diagnosed in almost 7 million Americans, millions more likely have symptoms but have not received a formal diagnosis — and insurance coverage for new biomarker testing, brain imaging scans and dementia-slowing medications depends on diagnosis. A diagnosis also can be important for accessing specialized care and support for individuals and their caregivers, according to the authors.
Dementia deaths rising
Meanwhile, another study has found that dementia-related deaths have tripled over the past 21 years, jumping from 150,000 in 1999 to 450,000 in 2020.
The findings, published in The Primary Care Companion for CNS Disorders, noted that the chances of dying from dementia increased in every demographic group studied. The authors attributed the steep increase in deaths to longer lifespan and earlier diagnosis. Although age is the most significant dementia risk factor, the increased prevalence of chronic conditions — heart disease, diabetes and obesity — also may be contributing factors, they said.
Using mortality data spanning 1999 to 2020 from the US Centers for Disease Control and Prevention, the researchers said they saw “concerning trends” in dementia-related mortality in the United States, highlighting a “critical need” for targeted healthcare policy initiatives aimed at mitigating the increasing dementia burden.
Women, Black adults and people living in rural communities had the greatest increase in dementia deaths during the study period.
By 2050, the number of people with dementia in the United States is projected to reach 10.5 million. But the authors also said that advances in dementia prevention are effective and accessible. The Lancet Commission on Dementia recently reported that up to 45% of dementia cases may be preventable by addressing 14 modifiable risk factors.
“Enhancing public health awareness regarding dementia risk factors, promoting screening and early detection, ensuring equitable healthcare access, and implementing effective health policy interventions hold the promise of substantially mitigating regional and racial disparities in dementia mortality across the United States,” the authors concluded. “Tailored interventions can be crafted to cater to the specific needs and challenges of specific populations and geographic areas.”
Demographics predict Alzheimer’s cognitive decline
Another new study found that older age, female sex, heart rhythms, daily activity levels and depression can help predict the decline of cognitive function in early-stage Alzheimer’s disease.
Researchers from Germany, France and Austria followed a cohort of 500 Austrian patients with probable and possible Alzheimer’s disease for two years to better understand which characteristics might best predict cognitive decline. Their findings were published Wednesday in the open access journal PLOS ONE.
The investigators found that age, female sex, difficulty with daily activities and depression predicted cognitive decline at every time point. Those characteristics, along with a history of atrial fibrillation, predicted the most severe cognitive decline after two years.
Changes in cognitive function also were strongly tied to increased caregiver burden, prompting the researchers to call for management strategies to consider the impact of the disease on caregivers as well as those in whom the disease has been diagnosed.
