We all know that as a society, our population is getting older and living longer than previous generations. And while that’s a wonderful trend if you are able to get more years of good health and quality living, the flipside of that is many of us will face, either for ourselves or our loved ones, cognitive impairment and dementia diagnoses in those later years. In fact, a new research study just reported in JAMA Neurology makes this stark and clear: Looking at a nationally representative sample of approximately 3,500 people who were 65 and older, the results showed that 10% of that population had dementia and another 22% had mild cognitive impairment, a condition between normal aging and a dementia diagnosis. They further confirmed that “the burden of cognitive impairment and dementia in the US is associated with increasing age.” In fact, while the rate of dementia diagnoses was determined to be 10% among those aged 65, that percentage rose with every 5-year increase in age, so that by age 90, 35% of the population had dementia. While there were no significant differences found between men and women, the race, ethnicity and educational attainment of the person was important: That is, Black adults suffer disproportionately from dementia and Hispanic older adults suffer disproportionately from mild cognitive impairment. Furthermore, each additional year of education was correlated with a lower risk of dementia and mild cognitive impairment.

This demographic data is sobering and all the more concerning given the apparent inequities in who bears the burden of dementia and cognitive impairment. The reality is that Black Americans are twice as likely to be diagnosed with Alzheimer’s and also bear the greatest costs of caring for loved ones who suffer from such diagnoses. While we previously described the use of PET scans as a way to confirm a dementia diagnosis in its earlier stages, the reality is that this technology remains out of reach for most adults, including those more likely to be diagnosed with dementia, because of restrictive Medicare coverage for these scans. Given that a study of the use of PET Scans for a dementia diagnosis reported a change in treatment for such patients 60% of the time, it’s critical that all patients, regardless of race, ethnicity, or socioeconomic circumstance get access to these scans and potentially life-altering treatment as a result. While the Biden administration has initiated a review of current Medicare coverage for these scans, innumerable patients and families are stuck in limbo without access to early diagnosis of their dementia via PET scans. This is all the more important given the new treatments for Alzheimer’s that are in the works.

And access to these scans is all the more important as we find out how early signs of dementia may appear in the brain prior to an actual diagnosis. According to a recent study by the University of Cambridge published in Alzheimer’s & Dementia, signs of brain impairment and cognitive and functional changes can appear in a person as early as 9 years prior to an actual dementia diagnosis. Study participants were ages 40-69 and were followed from 2006 – 2010. Those who subsequently developed Alzheimer’s scored worse on such tests as reaction time and numeric memory and pair-matching. Those who developed Alzheimer’s were also more likely to have fallen compared to those who were not diagnosed. The researchers concluded that “This is a step towards us being able to screen people who are at greatest risk- for example, people over 50 or those who have high blood pressure or do not do enough exercise- and intervene at an earlier stage to help them reduce their risk.”

Finally, in determining who may be at risk beyond the factors cited above, there is another new research study that found that those with multi-morbidity (for example, such chronic illnesses as hypertension, diabetes, and coronary heart disease) may be at significantly higher risk of dementia than those who do not have those co-morbidities. In fact, the research reports that having more than one chronic health condition or disease is associated with a 63% increased risk of developing dementia over a 15-year period. If that’s not motivation to try to stay healthy then it’s not clear what would be. But again, not all risks are within one’s control. The bottom line is that, at the moment, encouraging healthy lifestyles along with access to earlier diagnoses may be our best bet in containing the number of dementia diagnoses.