Sixty-five percent of health and care professionals and 80% of the general public globally believe dementia is a normal part of ageing, according to the World Alzheimer Report put out by Alzheimer’s Disease International last week.

“This is a concerning increase from our 2019 survey numbers, as we know that this lack of understanding can delay diagnosis and access to treatment and support,” the report stated.

Given how widespread this belief is, people may be minimising their symptoms and not presenting to their GP to discuss, says GP, Clinical Associate Professor and Dementia Australia medical advisor Dr Marita Long.

“This makes it more important that as GPs we start asking ‘How’s your memory going?’” Clinical Associate Professor Long says, noting that stigma is a barrier to risk reduction, according to the RACGP Red Book.

Some patients feel concerns not taken seriously

The report also cited qualitative research from patients who had raised concerns with their doctor, but felt they were not taken seriously.

“This is not surprising given dementia is not a compulsory part of GP education–despite it being the second leading cause of death overall and leading cause of disability in the over 65 patient population,” Clinical Associate Professor Long says.

Psychologist Lee-Fay Low, a professor in ageing and health at the University of Sydney, says it rings true to feedback her team has received while working on a campaign to encourage timely health-seeking for dementia in Western Sydney and Adelaide.

“Some people have said that doctors have said ‘there’s nothing to worry about’ or ‘it’s just part of getting old’ and not to worry about their memory and other problems. Some doctors have done a Mini-Mental or some similar test and said, ‘well, you’re fine,’ don’t worry about it,” Professor Low says.

This could be a missed opportunity to help raise awareness about prevention among those who are concerned, she says.

Clinical Associate Professor Long agrees.

“You can use CogDrisk to start conversations earlier to reduce risk and address stigma, so it becomes more normalised in the preventative health space, just like asking about heart health or depression or smoking,” Clinical Associate Professor Long says.

She also recommends the BrainTrack app which patients can use to monitor and understand suspected changes to their cognition – and discuss with their GP.

Professor Low says even if a screening assessment shows the person is okay, the doctor could offer risk reduction strategies and monitor them, she adds, suggesting the person come back in a year or 18 months to reassess.

Of course it may be something besides dementia, such as depression, vitamin b12 or folate deficiency, or they may indeed be fine, but doing a check-up and monitoring can put people at ease, she says.

“If people are raising the issue with their GPs, even if on a cognitive screening test they seem to be performing okay, if on a clinical history that the person has some functional difficulties, then it’s worth either doing a full checkup or referring to a geriatrician.”

“You can have a 30 out of 30 on a Mini-Mental and have dementia. We do diagnose people like that in our clinic.”

“The Mini-Mental is not a very sensitive instrument for some types of cognition and you can have a very mild dementia that it doesn’t pick up.”

Functional difficulties such as forgetting medications, not understanding instructions, missed appointments or taking way longer to use up medications than they should are all red flags that something cognitively or functionally could be awry, Professor Low says.

“And maybe there is nothing wrong now, but the monitoring might pick up something earlier on as well,” she says.

Clinical Associate Professor Long says it’s crucial to have some questions you can use as part of a functional assessment, such as:

• How are you managing cooking? Explore what they are doing e.g. heating up a meal or cooking from scratch
• How is your driving? Any knocks, accidents, can you find your car in the carpark?
• How are doing paying bills? Have you missed/forgotten any?
• Have you missed any appointments?

The report also mentions that patients living with dementia sometimes feel ignored by their care professionals, who address their carer instead – but it’s important to include them where possible, Professor Low says.

“What we do hear sometimes is that after the person is given a diagnosis of dementia, the GP will then talk to the carer like the person with dementia is no longer there. So dismissing them and directing all decision making to the carer rather than talking to the person with dementia,” she says.

Other findings from the report:

• Over a quarter of people globally incorrectly believe there is nothing we can do to prevent dementia
• 88% of people living with dementia indicate experiencing discrimination