Alzheimer’s and dementia treatment impacted by where you live
Someone living in one area of the U.S. might be twice as likely to receive a dementia diagnosis as someone in another area.
Dementia (CREDIT: UC Berkeley News)
With new medications emerging for Alzheimer's disease and other forms of dementia, a recent study reveals that the likelihood of receiving a diagnosis—and therefore access to these treatments—varies significantly depending on where you live.
The study highlights a wide range of diagnosis rates across different regions in the United States. These regional disparities are even more pronounced among individuals aged 66 to 74 and those who are Black or Hispanic.
According to the research, someone living in one area of the U.S. might be twice as likely to receive a dementia diagnosis as someone in another area. This suggests that the chance of being diagnosed may have more to do with the healthcare system in a particular region than with the individual’s own risk factors.
Access to advanced tests and treatments for dementia, which aim to slow the progression of the disease in its earliest stages, depends on a formal diagnosis. The study, published in Alzheimer's & Dementia: The Journal of the Alzheimer's Association, focuses on regional differences in what is termed “diagnostic intensity”—the variation in diagnosis rates that persists even when accounting for various risk factors and regional differences in healthcare availability.
Conducted by researchers from the University of Michigan, the study sheds light on how health system-level factors contribute to these disparities. “These findings go beyond demographic and population-level differences in risk, and indicate that there are health system-level differences that could be targeted and remediated,” says Dr. Julie Bynum, the lead researcher and a geriatrician at U-M Health.
The research team analyzed data from 4.8 million individuals aged 66 and older who were covered by traditional Medicare in 2019. Nearly 7 million Americans currently have a formal dementia diagnosis, but millions more likely have symptoms without a diagnosis.
Insurance coverage for biomarker tests, brain imaging scans, and dementia-slowing medications depends on having this diagnosis. Even for those who do not qualify for these advanced treatments, a confirmed diagnosis is crucial for accessing specialized care and support.
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The study’s findings are particularly concerning because previous research has identified many factors that increase an individual’s risk of developing dementia, such as high blood pressure, high cholesterol, and tobacco or alcohol use. However, this study is the first to show that regional differences in diagnosis rates cannot be fully explained by these risk factors alone.
The researchers examined diagnoses within 306 hospital referral regions (HRRs), areas defined by the Dartmouth Atlas of Health Care and commonly used in healthcare studies. Each HRR includes at least one hospital capable of performing advanced procedures, making them ideal for studying dementia diagnosis rates.
The study found that among the 4.8 million people examined, 143,029 received a new diagnosis of Alzheimer's or another form of dementia in 2019. In total, 356,656 individuals in the study had been diagnosed with dementia.
Overall, about 7% of people covered by traditional Medicare have a dementia diagnosis at any given time, with 3% being diagnosed annually. The researchers found that the prevalence of diagnosed dementia ranged from 4% to 14% depending on the HRR, and new diagnosis rates varied from 1.7% to 5.4%.
When breaking down the data by age and race, the researchers found significant variations. They also considered factors like education level, smoking, obesity, and diabetes rates—all known risk factors for dementia—and the overall intensity of chronic disease diagnosis in each HRR. Despite accounting for these factors, the study found that diagnostic intensity still varied widely.
People living in regions with the lowest diagnostic intensity were 28% less likely to be diagnosed with dementia compared to the national average, while those in areas with the highest diagnostic intensity were 36% more likely to be diagnosed. The highest concentration of diagnosed dementia cases was found in the southern U.S., a region also known for high rates of stroke and cardiovascular disease. However, this trend did not hold uniformly after adjusting for other factors.
The variations in diagnosis rates could be due to differences in clinical practices, such as how often primary care physicians screen for dementia or the availability of specialists to confirm a diagnosis. Cultural or personal factors, like whether individuals seek medical care for memory concerns or bring up cognitive issues during routine appointments, could also play a role.
While the study does not definitively say whether these variations indicate underdiagnosis or overdiagnosis, it suggests that regions with lower-than-expected diagnosis rates could benefit from investigating potential barriers to getting a diagnosis.
“The goal these days should be to identify people with cognitive issues earlier, yet our data show the younger age group of Medicare participants is the one with the most variation,” says Bynum. For communities and health systems, this should be a call to action to spread knowledge and increase efforts to make services more accessible. For individuals, advocating for your own cognitive health, including requesting cognitive checks, is crucial.
Medicare offers coverage for a cognitive screening during each enrollee’s annual wellness visit. Additionally, Medicare’s recently launched GUIDE model for dementia care could improve care by incentivizing practices to better coordinate dementia care and provide around-the-clock access to trained providers.
Note: Materials provided above by The Brighter Side of News. Content may be edited for style and length.
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