Older adults with undiagnosed dementia are more likely to engage in potentially unsafe activities - such as driving - than those who have received a formal diagnosis.
The study found that older adults who had symptoms of dementia but who had not been formally diagnosed were almost twice as likely to drive, cook, manage medication, or undertake other activities that might put them in harm's way, compared with adults who had received a dementia diagnosis.
Lead author Dr. Halima Amjad, of the Division of Geriatric Medicine and Gerontology at Johns Hopkins, and colleagues recently published their findings in the Journal of the American Geriatrics Society.
Dementia is a term used to describe a number of diseases characterized by a decline in memory and thinking skills. Alzheimer's disease is the most common form of dementia, accounting for around 60-80 percent of all cases.
Symptoms of dementia may vary from person to person, though problems with short-term memory - such as remembering to pay bills, keeping track of a wallet or keys, or remembering appointments - reduced concentration, and poor reasoning and judgment are common signs.
At present, there is no single test to diagnose dementia; Alzheimer's and other forms of dementia are diagnosed based on the individual's medical history, a physical examination, and changes in memory and everyday functioning and behavior.
Comparing unsafe activity in diagnosed vs. undiagnosed dementia
Previous studies have shown that individuals with dementia are at greater risk for safety issues when engaging in certain activities, compared with those without the condition.
However, Dr. Amjad and colleagues note that such studies have included a small number of patients and have only investigated the effect of dementia on single issues.
For this latest research, the team analyzed data of 7,609 adults aged 65 and older who were part of the National Health and Aging Trends Study (NHATS) - an ongoing Johns Hopkins study that started in 2011.
As part of this study, participants underwent regular in-person interviews, which gathered a wealth of information, including data on daily life activities, living arrangements, and well-being.
Participants also underwent regular cognitive tests and physical examinations, used to assess their health as they aged.
For the purpose of their investigation, Dr. Amjad and colleagues allocated the participants to one of four groups:
- Adults who had received a formal diagnosis of dementia from a doctor, based on reports of such a diagnosis from themselves or a companion
- Adults who had dementia based on cognitive test scores and interviews, but who had not been formally diagnosed by a doctor - defined as having "undiagnosed" dementia
- Adults with possible dementia
- Adults without dementia.
The team analyzed subjects' engagement in any activities that could be deemed unsafe to participate in with symptoms of dementia, such as driving, caring for another person, managing finances, handling medication, and preparing hot meals.
Awareness of functional problems lacking with undiagnosed dementia
The results of the study did present some good news. Compared with adults who had possible dementia or no dementia, those who had diagnosed or undiagnosed dementia were less likely to engage in potentially unsafe activities.
For example, only 23 percent of older adults with undiagnosed dementia engaged in driving, compared with 59 percent of those with possible dementia and 84 percent without dementia.
- There are around 46.8 million people worldwide living with dementia
- There are around 9.9 million new dementia cases diagnosed across the globe each year
- By 2050, it is estimated there will be around 131.5 million people with the condition.
"That in itself is good news, though the numbers are still important from a public health and safety standpoint," notes Dr. Amjad. "Either the patients themselves or their family members are self-regulating and doing these activities less frequently as their disease is progressing."
However, the study results also revealed that, compared with adults who had received a formal diagnosis of dementia, those with undiagnosed dementia were much more likely to participate in unsafe activities.
For instance, they found that around 28 percent of adults with undiagnosed dementia engaged in driving, compared with almost 17 percent of those with diagnosed dementia.
Around 29 percent of adults with undiagnosed dementia were still handling their finances, compared with only 12 percent of those with diagnosed dementia.
A total of 42 percent of those with undiagnosed dementia continued to prepare hot meals, compared with just 17 percent of those with diagnosed dementia.
Furthermore, around 50 percent of adults with undiagnosed dementia were still preparing their own medication, compared with 22 percent with diagnosed dementia.
"When patients receive a formal dementia diagnosis, their families are typically aware that, at some point, their loved ones will not be able to drive or will need more help with their medicine," explains Dr. Amjad.
"But when people are undiagnosed, families and friends may ignore or be unaware of functional problems that already exist."
A 'wake-up call' for doctors, families of older adults
According to study co-author David Roth, Ph.D., director of the Johns Hopkins Center for Aging and Health, the findings raise some important questions about dementia diagnosis.
"First, are those with dementia receiving adequate medical care, including accurate and up-to-date diagnoses?" she asks. "Second, are diagnoses of dementia being properly communicated to patients and their families?"
Dr. Amjad adds that the results should be a "wake-up call" for doctors who care for the elderly and the families of loved ones who might be in the early stages of dementia.
"If elderly patients are having difficulty with activities, they may benefit from a physician formally screening them for dementia.
But families are really the front line in recognizing when someone shouldn't be driving or needs more help with managing medicines. That means being watchful and aware as loved ones get older and dementia is more likely."
Dr. Halima Amjad