Improving community health‐care systems’ early detection of cognitive decline and dementia

Abstract

Preliminary estimates suggest that current global health-care systems lack the resource capacity to provide persons with dementia timely access to diagnosis, treatment, and care. There is an increasing need to improve timely identification of individuals who will likely progress to Alzheimer's disease (AD) dementia particularly among under-represented, underserved, and vulnerable populations. The rapidly evolving area of bioinformatics of health system data and the emergence of fluid-based biomarkers for pre-symptomatic AD may provide an innovative strategic option for health system planners. A think-tank style meeting entitled "The Campaign to Prevent Alzheimer's Disease Work Group on Community-Based Detection and Assessment of Cognitive Decline" developed recommendations to guide future sustainability activities, public policy campaigns, and implementation pilots. The group identified and explored different pathways of community-based detection using electronic health records, from different international health-care systems, to detect and surveil individuals with early possible cognitive impairment. BACKGROUNDDespite enjoying the current longevity revolution, global society is now on the precipice of a new form of political and economic instability. The crisis is composed of escalating costs for the diagnosis, assessment, treatment, and care of many age-associated disorders that affect memory, movement, and mood. Further, this burden is magnified doubly by the dementia and SARS-CoV-2 pandemics stressing already existing and inadequate health-care service delivery programs for older adults. 1 Dementing illnesses, driven primarily by the most prevalent cause, Alzheimer's disease (AD), remain one of the largest global public health challenges facing health care today. There are now upward of 50 million people living with dementia and the global cost of dementia was estimated to be US$1.3 trillion in 2019. 2 Most of these costs occur in high income countries (HICs) although most people with dementia live in low/middle income countries (LMICs). If incident dementia predictions continue over the next 10 years, the global costs of dementia will increase to a projected US$1.7 trillion by 2030. 2 These global estimates increase to US$2.8 trillion by 2030 with corrections for increases in care costs. 2The global societal dementia burden is the key motivation for the various national and international dementia prevention initiatives over the past decade. The earliest efforts examined the issue of how to accelerate pharmaceutical intervention development. Next, the research community's focus shifted to explore opportunities to develop accurate assessment technologies in asymptomatic/early impairment individuals and to evaluate the effectiveness of non-pharmacological/lifestyle interventions. Today, there is a growing level of interest in identifying key public health opportunities that lessen the burden of disability due to dementia and its comorbid conditions at the community level. [3][4][5] The early and accurate asses...