In December, the Alzheimer’s Association released guidance to help health care providers detect cognitive impairment as part of the Medicare Annual Wellness Visit (AWV). While physicians have been required to include detection of cognitive impairment as part of the AWV since its inception in January 2011, there had not been any comprehensive guidance for physicians on how to undertake the assessment.

Detecting possible cognitive impairment is critical to the work of public health and the first step in determining whether further evaluation is needed. In developing the recommendations, the Alzheimer’s Association convened an expert workgroup to survey the current literature and build consensus around an effective, practical and easy process that could be used in the primary care setting. The result was the development of an algorithm for the AWV that involves the use of various possible detection tools.

Use of a valid tool allows clinicians to obtain an objective score that can improve detection of cognitive impairment and indicate when a full dementia evaluation is needed. One study found that structured tools detected more than 80 percent of patients who, during follow-up evaluations, were diagnosed with mild cognitive impairment or dementia. That compares to the detection of only 59 percent when initial assessment relied on physician observation alone.

Early diagnosis and detection are part of the Alzheimer’s Association’s public health agenda and are essential to providing the best medical care and outcomes for those with the disease. Even without a way to cure or slow the progression of Alzheimer’s disease, early detection offers the best opportunities for early intervention and maintenance of independent living, including support of healthy living that may lessen secondary disorders and enhance quality of life.

Alzheimer’s Burden and Mortality Increases Worldwide 

The leading causes of death and disability around the world have shifted from infectious diseases to non-communicable diseases, such as Alzheimer’s and dementia, according to the Lancet’s 2010 Global Burden of Disease (GBD 2010) report. This report is the largest systematic effort to describe global burden of disease, injury, and health risk factors.

Specifically, the GBD 2010 shows that global mortality due to Alzheimer’s disease and other dementias rose by 244 percent between 1990 and 2010. Only deaths from HIV/AIDS and natural disasters rose at a higher rate during the same period.

In addition, the report shows the burden of Alzheimer’s is also rising. The GBD 2010 uses a population health measure – Disability Adjusted Life Years (DALYs) – to represent years of healthy life lost due to death and disability. The DALY for Alzheimer’s disease and other dementias has increased 53 percent since 1990. In Western Europe and high-income North America (Canada and the United States), Alzheimer’s and other dementias is, respectively, the 11th and 12th leading cause of burden.

Overall, the GBD 2010 shows a global decline in infectious diseases, malnutrition, and maternal injury and death, while the prevalence of non-communicable diseases has increased. Life expectancy for both men and women has increased, but both men and women are living with more disability and illness.

SPOTLIGHT: DIAGNOSIS

In a new feature of the Alzheimer’s Public Health News, each issue, we will be spotlighting in depth a particular Alzheimer’s issue of importance to public health officials.

Studies indicate that as many as half of people with Alzheimer’s disease and other dementias have not been diagnosed – a glaring gap that calls for a public health response. What does it mean to have an Alzheimer’s diagnosis? Why is an early diagnosis important? And what can the public health community do? Learn about diagnosis of Alzheimer’s disease in this month’s Alzheimer’s and Public Health Spotlight.