Cognitive Screening Beliefs and Behaviors Among Older US Adults: Results from the National Poll on Healthy Aging

Abstract

AbstractBackgroundFewer than half of people with dementia have been formally diagnosed by a clinician. Consequently, the US National Plan to Address Alzheimer’s Disease (AD) has prioritized early disease detection. A critical first step to early detection is primary care‐based screening for cognitive decline. Greater understanding of public perceptions and use of cognitive screening is needed to optimize early detection of AD among older adults.MethodWe analyzed data from the March 2023 fielding of the University of Michigan National Poll on Healthy Aging, a nationally representative web and telephone survey of community‐dwelling US adults aged 50‐80 using the NORC AmeriSpeak panel. Respondents for this analysis were aged 65‐80 without AD or dementia. Our primary outcome was self‐reported history of cognitive screening (never versus ever had screening). Logistic regression was used to estimate associations between respondent characteristics (i.e., sociodemographic factors, health factors, beliefs about cognitive screening) and self‐report of cognitive screening, and to examine whether primary care provider status moderates the association between screening beliefs and self‐report of screening.ResultOf 1,242 respondents, 42% reported having ever undergone cognitive screening (21% within the past year). In adjusted analyses, sociodemographic factors (i.e., older age, higher level of education), insurance status (Medicare Advantage vs. traditional Medicare) and poorer physical health were associated with greater likelihood of cognitive screening (all p<0.05). Respondents with positive versus negative beliefs about cognitive screening were 45% more likely to report screening (adjusted risk ratio: 1.45, p<0.001). The probability of cognitive screening did not vary overall by provider status; however, among respondents with negative beliefs about screening, having a provider was associated with greater probability of having undergone screening (35% versus 11%, p<0.05).ConclusionWe identified a range of factors associated with older adults’ self‐report of cognitive screening including age, health, and beliefs about the pros and cons of screening. Primary care providers may play an important role in cognitive screening decisions, particularly among patients with negative beliefs about screening. Providers can play an active role in initiating conversations about cognition with older adult patients on the advantages and disadvantages of screening to help patients make informed decisions.