Self-Reported Dementia-Related Diagnosis Underestimates the Prevalence of Older Americans Living with Possible Dementia

Article type: Research Article

Authors: McGrath, Ryan^{a; b} | Robinson-Lane, Sheria G.^c | Clark, Brian C.^{d; e; f} | Suhr, Julie A.^{d; g} | Giordani, Bruno J.^h | Vincent, Brenda M.ⁱ

Affiliations: [a] Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND, USA | [b] Fargo VA Healthcare System, Fargo, ND, USA | [c] School of Nursing, University of Michigan, Ann Arbor, MI, USA | [d] Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, USA | [e] Department of Biomedical Sciences, Ohio University, Athens, OH, USA | [f] Department of Geriatric Medicine, Ohio University, Athens, OH, USA | [g] Department of Psychology, Ohio University, Athens, OH, USA | [h] Department of Psychiatry, Neurology, and Psychology, University of Michigan, Ann Arbor, MI, USA | [i] Department of Statistics, North Dakota State University, Fargo, ND, USA

Correspondence: [*] Correspondence to: Ryan McGrath, Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, NDSU Dept 2620; PO Box 6050, Fargo, ND 58108-6050, USA. Tel.: +1 701 231 7474; Fax: +1 701 231 8872; E-mail: [email protected].

Abstract: Background:Dementia screening is an important step for appropriate dementia-related referrals to diagnosis and treat possible dementia. Objective:We sought to estimate the prevalence of no reported dementia-related diagnosis in a nationally representative sample of older Americans with a cognitive impairment consistent with dementia (CICD). Methods:The weighted analytical sample included 6,036,224 Americans aged at least 65 years old that were identified as having a CICD without history of stroke, cancers, neurological conditions, or brain damage who participated in at least one-wave of the 2010–2016 Health and Retirement Study. The adapted Telephone Interview of Cognitive Status assessed cognitive functioning. Those with scores≤6 were considered as having a CICD. Healthcare provider dementia-related diagnosis was self-reported. Age, sex, educational achievement, and race and ethnicity were also self-reported. Results:The overall estimated prevalence of no reported dementia-related diagnosis for older Americans with a CICD was 91.4%(95%confidence interval (CI): 87.7%–94.1%). Persons with a CICD who identified as non-Hispanic black had a high prevalence of no reported dementia-related diagnosis (93.3%; CI: 89.8%–95.6%). The estimated prevalence of no reported dementia-related diagnosis was greater in males with a CICD (99.7%; CI: 99.6%–99.8%) than females (90.2%; CI: 85.6%–93.4%). Moreover, the estimated prevalence of no reported dementia-related diagnosis for non-high school graduates with a CICD was 93.5%(CI: 89.3%–96.1%), but 90.9%(CI: 84.7%–94.7%) for those with at least a high school education. Conclusion:Dementia screening should be encouraged during routine geriatric health assessments. Continued research that evaluates the utility of self-reported dementia-related measures is also warranted.

Keywords: Aging, cognitive dysfunction, geriatric assessment, geriatrics, healthcare disparities

DOI: 10.3233/JAD-201212

Journal: Journal of Alzheimer's Disease, vol. 82, no. 1, pp. 373-380, 2021