More than six million Americans have Alzheimer’s disease, but many have not received a formal diagnosis, even though cognitive screening, or memory testing, is widely available.

The early detection of Alzheimer’s disease has become a public health priority. The earlier cognitive decline can be detected, the sooner patients can get access to new treatments such as lecanemab (Leqembi, Eisai/Biogen), be referred to clinical trials of new therapies and plan for the future. When symptoms become severe enough to impact patients’ daily lives, it is too late.

According to new findings from the University of Michigan Poll on Healthy Aging, although 80 percent of respondents said they saw the benefit of cognitive testing; 80 percent said they had not been tested within the last year. Fifty-nine percent said they had never been tested, and 60 percent of respondents said they thought primary care providers should offer yearly testing to older adults — even though it is a required part of Medicare annual wellness visits.

Patients wait for providers to recommend cognitive testing and providers wait for patients or family members to raise concerns.

“It is important for patients and their families to know that this is something that should and can be offered to them at their annual wellness visits. Screening is covered through their plan,” Chelsea Cox, who contributed to a report of the poll findings, told TheDoctor.

Barriers to communication in a primary care setting can lead to delays in detecting cognitive decline. Reluctance on the part of patients and providers to bring up the issue of cognitive testing may contribute to low rates of screening, Cox added. Patients wait for providers to recommend cognitive testing and providers wait for patients or family members to raise concerns.

“The benefits of early detection are why conversations between patients and providers about cognitive testing are so important,” said Cox, a doctoral candidate at the University of Michigan School of Public Health. Though primary care providers are required to detect cognitive impairment at Medicare Annual Wellness Visits, previous studies indicate they want more training on when and how to screen and what tools to use, she said.

The poll also asked respondents about their knowledge of blood tests to detect tau and amyloid proteins, which build up in the brain of those with Alzheimer’s disease. Only 17 percent were familiar with these tests, less than one percent had had one and nine percent would like to get tested. Currently, these tests are only available to patients with cognitive impairment through a specialist in brain diseases. However, Cox explained, “They are an up-and-coming tool for the early detection of Alzheimer’s disease and related dementias.”

The University of Michigan researchers plan to publish this data in a peer-reviewed journal and want to do further analyses. Since any information that identifies patients has been removed, the data can be used by researchers anywhere. “"Many different questions can be answered using these data,” said Cox, who presented the poll findings at the Alzheimer’s Association International Conference 2023 in Amsterdam, the Netherlands.

The University of Michigan National Poll on Healthy Aging was done online and by phone in March 2023 for the University of Michigan Institute for Healthcare Policy and Innovation. More than 1,200 Americans between the ages of 65 and 80 took part in the survey.