TOPLINE:
Detection rates of mild cognitive impairment (MCI) in primary care are extremely low, with only about 8% of expected cases diagnosed on average, a finding that points to an urgent need to improve early detection in primary care.
METHODOLOGY:
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Researchers estimated MCI detection rates among 226,756 primary care clinicians and 54,597 practices that had at least 25 patients enrolled in Medicare between 2017-2019.
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They compared the expected number of MCI cases, based on a predictive model, to actual diagnosed cases as documented in claims and encounter data.
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They accounted for uncertainty in these estimates to determine whether detection rates are within the expected range or significantly higher or lower.
TAKEAWAY:
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More than 25% of clinicians and practices did not have a single patient with diagnosed MCI; the average detection rate was 0.01 for both clinicians and practices.
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The modeled expected MCI detection rate, however, was much higher (average 0.19 for clinicians and 0.20 for practices).
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Average detection rates for clinicians and practices was 0.08, with more than 99% of clinicians and practices underdiagnosing MCI; clinicians practicing geriatric medicine had higher detection rates than others.
IN PRACTICE:
The findings are “concerning not only because patients might not get identified for a disease-modifying AD treatment in time, but also because numerous causes of MCI — such as hypothyroidism and medication side effects — are reversible, and the condition itself can be stabilized by lifestyle modification interventions,” the authors write.
SOURCE:
The study, with first author Ying Liu, PhD, from University of Southern California, Los Angeles, was published online October 24 in the Journal of Prevention of Alzheimer’s Disease.
LIMITATIONS:
The predictive model based on demographic information has only moderate accuracy. Expected prevalence of MCI was based on cognitive test scores, which is not the same as a true clinical diagnosis.
DISCLOSURES:
The study was partially funded by a contract from Genentech to the University of Southern California. Co-authors Soeren Mattke and Christopher Wallick have disclosed relationships with Genentech.
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