This free exam lets you know what’s normal…and what’s not…
One of your favorite actors appears on the screen, but you can’t put a name to the face. Or you walk into the kitchen for—well, you walked in there for something, but you can’t remember what.
Sound familiar? If so, you are probably at least middle-aged. These and other memory hiccups usually reflect nothing more than normal brain changes, but how can you be sure? It’s a legitimate concern because up to 76% of cases of cognitive impairment aren’t spotted by primary care physicians during the mild-to-moderate phases.
Recent development: You may have heard about the “annual wellness visit” that the Affordable Care Act has added as a new Medicare/Medicaid benefit. As you might imagine, this free checkup includes standard tests (such as blood pressure), a review of screening tests, etc. But this exam also includes a thorough assessment to detect memory problems or other cognitive impairments. Some private insurance policies may also cover this type of exam.
Why it’s important: People with Alzheimer’s or other forms of dementia are typically diagnosed three to five years after they’ve developed impairments. The cognitive checkup offers the chance for earlier detection of a problem and the opportunity to develop an effective plan for coping with symptoms of cognitive impairment.
WHAT THE EXAM INCLUDES
During the annual wellness visit, your doctor will start with a general health assessment. If you’re like most adults, you probably have one or more health issues—such as high blood pressure or diabetes—that increase the risk for cognitive impairments. Certain medications can also cause cognitive problems.
The exam (combined with subsequent tests) can also help identify reversible causes of cognitive declines, such as thyroid problems, low vitamin B-12 and depression.
After that, the exam will include…
Personal stories. Your doctor will ask how your life is going. This is your chance to discuss any changes you might have noticed—maybe it’s getting harder to balance your checkbook…perhaps you’re forgetting to take medications (or you’re taking them at the wrong times). Buttoning clothing might be harder…possibly you’ve slipped and fallen in the bathroom…or maybe you’ve felt depressed lately. Such self-reported observations can raise important red flags.
A conversation with a family member/close friend. It’s common for patients with cognitive changes to be unaware (or only partly aware) of how much they’re affected. You may think that you’re on top of daily details, but someone else in your life might notice that you keep missing appointments or taking wrong turns on your drive home. A different perspective is helpful.
My advice: I strongly encourage patients to bring someone with them to their wellness visits whether they suspect cognitive problems or not. The doctor or a member of the medical team may interview the person separately so that he/she can speak freely. If you and your companion say that your memory is good, there’s a strong likelihood that everything’s fine…and that you won’t need further testing for another year.
POSSIBLE PROBLEM AREAS
If you have noticed changes in your memory or daily routines, your doctor will ask focused questions.
Examples: “During the last 12 months, have you noticed that confusion/memory loss is happening more often or getting worse?” “Did you need help from others during the last week in performing daily activities, such as grooming, walking or getting dressed?”
Problems in any of these areas could mean that you need…
Cognitive testing. If your doctor suspects (based on the above discussions) that you might have some degree of cognitive impairment, commonly used tests include the Memory Impairment Screen (MIS)…the General Practitioner assessment of Cognition (GPCOG)…or the Mini-Cog. Each can be administered by a medical staff member in less than five minutes.
Example: The MIS is a verbally administered word-recall test. You might be asked to read four words—for example, checkers, saucer, telegram and bus—out loud. Then you’ll be told to think of categories (such as “games”) and come up with words that fit in each category. After a few minutes, you’ll be asked to remember the four words you read earlier. You may also be asked to spell a word (such as “world”) backward…or count back from 100 by sevens.
Patients who “fail” a test may have cognitive impairments—or they could simply be having an off day. Further evaluation by a neurologist, geriatrician or other specialist will be recommended.
If the wellness visit and subsequent testing point to a cognitive decline, you’ll need appropriate follow-up.
Recent research: The collaborative care model (a team approach to care) has been shown to be more effective than the standard one-doctor/one-patient approach. With the collaborative approach, a team of clinicians (which may include a primary care doctor and memory care doctor) led by a care coordinator (a registered nurse or a social worker) works with the patient and family to improve quality of care.
In a study of 153 patients with mild-to-moderate Alzheimer’s, patients who received collaborative care had fewer behavioral/psychological problems and were more likely to be given effective drug treatments than patients receiving “standard” care with one doctor.
Many patients can live a relatively normal life with cognitive decline, but they’ll need a lot of help along the way. A collaborative program is the best way to provide it.
Note: All aspects of this care may not be covered by insurance.