Physician Perceptions about the Barriers to Prompt Diagnosis of Mild Cognitive Impairment and Alzheimer’s Disease

Abstract

Prior studies have identified numerous barriers to the prompt diagnosis of patients with suspected Alzheimer’s disease (AD). The aim of the study was to evaluate physician’s perceptions of the importance of previously identified barriers to diagnosis, but with a specific focus on the presentation of mild cognitive impairment (MCI), which may be indicative of neurodegenerative disorders such as AD. A second aim was to evaluate how the perspective of primary care physicians (PCPs) may differ from that of specialists. A cross-sectional online survey of PCPs and specialists who routinely manage patients with complaints of age-related cognitive impairment was conducted. Participants were asked to identify barriers to prompt diagnosis from prespecified lists of known diagnostic challenges categorized into 4 domains: patient-related, physician-related, setting-related, and those relating to the clinical profile of AD. Physicians report a range of barriers when attempting to diagnose MCI and AD. Major themes included patients seeing cognitive decline as a normal part of aging and not disclosing symptoms, long waiting lists, and a lack of treatment options and definitive biomarker tests. Generally, PCPs and specialists showed broad agreement; however, PCPs were more likely to identify burdens on the healthcare system, such as long waiting lists and inadequate time to evaluate patients. Substantial barriers continue to hinder early diagnosis of MCI and AD. There are numerous areas where improvements might be made but the implementation of potential interventions will likely be associated with financial strain for many healthcare systems.

Dementia assessment and diagnostic practices of healthcare workers in rural southwestern Uganda: a cross-sectional qualitative study

“…Specialized mental health workers were unlikely to hold this view, further demonstrating and underlining the importance of mental health training in dementia assessment and diagnosis care. Our observation fits with data worldwide showing that both the general public and healthcare workers often viewed memory loss as a normal part of the aging process [25][26][27][28].…”

Small-Molecule Amyloid Beta-Aggregation Inhibitors in Alzheimer's Disease Drug Development

“…28 Indeed, recent and ongoing clinical trials in AD continue to experiment with very early drug interventions in attempts to develop a disease-modifying agent but unfortunately, so far, no such approved agents are currently available. 29 Some small molecules are able to inhibit the formation and extension of Aβ fibrils, and also destabilize Aβ fibrils in vitro. These include natural compounds or commercially available bioactive compounds, drugs, surfactants, Cu/Zn chelators, phenothiazines, and sulfonated dyes such as Congo red (CR) and thioflavin T (ThT).…”

“…Therefore, preventing the conformational transition of the Aβ monomer from an initial random coil or α-helix into a β-sheet is the primary goal of blocking Aβ toxicity by small-molecule inhibitors. 38 The amino acid sequence of human Aβ42 is: NH2-1 Asp-2 Ala-3 Glu-4 Phe-5 Arg- 6 His-7 Asp-8 Ser-9 Gly-10 Tyr-11 Glu-12 Val-13-His- 14 His- 15 Gln- 16 Lys- 17 Leu- 18 Val- 19 Phe- 20 Phe- 21 Ala- 22-Glu- 23 Asp- 24 Val- 25 Gly- 26 Ser- 27 Asn- 28 Lys- 29 Gly- 30 Ala- 31 Ile- 32 Ile- 33 Gly- 34 Leu- 35 Met- 36 Val- 37 Gly- 38 Gly- 39 Val- 40 Val- 41 Ile-42 Ala-COOH. Residues 1 Asp- 28 Lys and 29 Gly- 42 Ala respectively represent a hydrophilic domain and a hydrophobic domain.…”

“…80 There are 12 important residues ( 4 Phe, 5 Arg, 19 Phe, 20 Phe, 22 Glu, 28 Lys, 29 Gly, 34 Leu to 37 Gly, and 41 Ile of Aβ) that strongly interact with EGCG. Simultaneously, the side chains of some hydrophobic residues (Phe, Met, and Ile) and the main chains of 28 Lys and 29 Gly provide nonpolar interactions with Aβ. These causes remodeling of mature Aβ fibrils and toxic oligomers into smaller nontoxic aggregates with the loss of β-sheet content.…”

Cognitive screening for early detection of mild cognitive impairment

“…Similar to primary prevention strategies for diseases such as cancer, heart disease, and diabetes, regular screening for cognitive impairment should be an essential component of clinical care for older patients. In addition to promoting early detection and early intervention, regular screening can help to address patients' reluctance to disclose cognitive problems to their physicians and reduce the stigma associated with cognitive disorders (Judge et al, 2019). Physician-related barriers also exist and should be addressed in order to help physicians identify when cognitive impairment is an issue and signals a risk for neurological disease.…”