The authors of the study undertook an analysis of Medicare Fee-for-Service records for 4,842,034 older Medicare beneficiaries from 2018 to 2019 to observe diagnoses of Alzheimer’s disease and related dementias (ADRD).
They found the intensity of ADRD diagnosis differed from place to place, regardless of population risk factors, such as education level, obesity, smoking habits, and a diagnosis of diabetes.
Diagnosis intensity ranged from 0.69 to 1.47 among hospital referral regions.
Lycia Neumann, PhD, senior director of Health Services Research at the Alzheimer’s Association of America, who was not involved in the study, told that “Alzheimer’s disease and other dementias are often underdiagnosed, as data in the 2024 Alzheimer’s Disease Facts and Figures report shows. And, as this newly published paper demonstrates, there are important geographical differences in dementia diagnosis rates, which are aggravated by age and racial/ethnic disparities.
First author of the study, Julie P. W. Bynum, MD, a professor of geriatric and palliative medicine at Johns Hopkins School of Medicine, noted that, with our data alone, we cannot say for sure what drives the differences.
The attitudes of patients and their families may also play a role, Bynum further hypothesized. There could be differences in the attitude and beliefs about dementia of the people being served by those systems. Things like believing dementia is a normal part of aging, or greater concern about stigma, or thinking no one has anything to offer to help them and their family. For Black and Hispanic people, reported Bynum, there are many studies across diseases that suggest lower access to healthcare, as well as lower levels of care seeking and diagnosis, and all of those social determinants of health apply to dementia, too. There are other issues that may result in under diagnoses for older people in the 66–74 years age range.
First, clinicians may not suspect dementia because it is, in fact, less common in younger people. Second, the diagnosis is tricky to make in earlier stages when symptoms can be subtle and have other contributors, like depression.oned: It is important to consider that the study is based on data from 2018-2019 claims. Advancements in diagnostic tools, such as blood tests, which are less invasive and costly, may help improve access to diagnosis in the future. For example the Alzheimer’s Association funded research that led to advancements in diagnosis through advanced imaging, fluid biomarkers and blood.
The Association, she added, is also working now to increase awareness regarding signs and symptoms, and improve access to and quality of diagnosis, treatment, and care. Neumann is one of the chairs working with a multidisciplinary scientific committee that will be bringing together experts — including researchers and practitioners — from around the country in November 2024 for a conference on Exploring Equity in Diagnosis to advance science and collaboration around identifying, understanding, and addressing disparities in dementia diagnosis
