AlzForum.org excerpt – Poor physical health, difficulty with daily routines, and low scores on tests of thinking, memory, and information processing most strongly predict dementia later in life, according to a new report by the RAND Corporation, a nonprofit research organization funded by private and government sources. A trio of studies, sponsored by Genentech and conducted by RAND Social and Economic Well-Being, identified key predictors of dementia risk, addressed the benefits of detecting cognitive impairment early—including better planning for future care—and identified barriers to routine cognitive screening in older adults, such as cost and limited access to effective disease-modifying treatments.
“These interesting studies end with excellent recommendations. There is much that individuals can do to decrease the chance of dementia, and this is a cause for optimism and hope,” said Gill Livingston, University College London, the senior author of the Lancet Commission on Dementia. The reports’ findings align with established research, including those from the commission (Livingston et al., 2024; Aug 2017 conference news; Aug 2020 conference news).
High cost emerged as the greatest impediment to people seeking cognitive testing. One study, led by Susann Rohwedder, used data from the RAND American Life Panel—an internet survey of 1,439 individuals aged 50–70—to explore participants’ likelihood of taking a cognitive test, visiting a specialist for follow-ups, or taking a disease-modifying treatment. While 80 percent of respondents said they would take a free cognitive assessment, only 40 percent said yes when the hypothetical cost was $300. Treatment effectiveness also influenced decisions: With access to a modestly effective treatment, the likelihood of someone agreeing to testing inched up from 55 percent to 60 percent, or 66 percent if that treatment was guaranteed to have no side effects. Financial concerns—such as higher long-term care insurance costs following a positive test result—also acted as a deterrent. Rohwedder and colleagues suggested implementing stronger confidentiality protections to reassure patients that their results would be kept private.
Sixty percent said they would take a disease-modifying treatment if it provided three additional years of independence, compared to 45 percent for a treatment offering six months. These numbers varied slightly by demographics. Wealthier or more educated people were more likely to seek testing and treatment.
The RAND economists recommended making cognitive testing free of charge to increase participation and adding it to regular medical checkups or providing financial support to broaden access. Yearly cognitive checkups have been covered by Medicare since 2011 as part of the annual wellness visit mandated by the Affordable Care Act, but not all doctors incorporate them (Mar 2019 news). Alzheimer’s blood tests on the horizon might also shift attitudes toward dementia screening (Nov 2024 conference news).
