The Changing Landscape of Alzheimer’s Detection

Alzheimer’s detection and treatment is full of obstacles, but an emerging challenge makes diagnosing and treating individuals with Alzheimer’s even more difficult. A national shortage of neurologists means patients face longer wait times and difficulty finding care, and based on data, this shortage is poised to worsen. At the same time, evolving diagnostic and treatment methods provide hope as the landscape of Alzheimer’s detection changes.

The Neurologist Shortage and Its Impact on Patients

Dr. Carl Paige, CMO and co-founder of Medical Transformation Center

According to the Alzheimer’s Association 2024 Alzheimer’s Disease Facts and Figures report, 20 states have been identified as “dementia neurology deserts.” These states are predicted to have fewer than 10 neurologists per 10,000 people with dementia by 2025. The report indicates than an estimated 6.9 million Americans are living with Alzheimer’s dementia. The number of people age 65 and older with Alzheimer’s dementia is projected to reach 13.8 million by 2060, which could exacerbate the neurologist shortage.

The neurologist shortage is already evident in the distance that patients often travel to see their neurologists. A research article published in September 2023 reviewed a 2018 Medicare sample of patients who had at least one outpatient neurologist visit. The data indicates that of the 563,216 Medicare beneficiaries reviewed, 17% traveled long-distance for care. Those patients traveled a median driving distance of 81.3 miles and 90 minutes compared to 13.2 miles and 22 minutes for patients who didn’t travel long distance. Low neurologist density was one of the factors associated with this extended travel.

Dr. Carl Paige, CMO and co-founder of Medical Transformation Center, explains that the lack of neurologists or primary care physicians will mean that individuals will have trouble accessing care in a timely fashion. “This correlates with delays in an accurate diagnosis,” he says. “The sooner an accurate diagnosis is made, the sooner specific targeted care and management can be initiated. It is likely that as specific diagnostic or care models are developed, then evaluation and management will be undertaken by mid-level providers.”

Kristie Tse, LMHC, founder and clinical director at Uncover Mental Health Counseling

Kristie Tse, LMHC, founder and clinical director at Uncover Mental Health Counseling, notes that the neurologist has profound impacts on individuals with Alzheimer’s. In addition to delaying diagnosis and treatment, lack of access to neurologists can mean that symptoms become exacerbated, putting a strain on families. “In my role as a psychotherapist, I emphasize the importance of culturally sensitive mental health support during these gaps,” Tse says. “With the emergence of the blood test to measure beta-amyloid levels, there’s potential to bridge some of these challenges by facilitating earlier detection even without immediate specialist intervention. This could allow us as mental health professionals to engage sooner with those affected, providing critical support and resources during their journey with dementia.”

Advancements in Alzheimer’s Screening and Diagnostics

Thankfully, there have been key advancements in Alzheimer’s screening and diagnostics, providing neurologists and specialists with more tools. “New tests are available that include blood markers associated with an Alzheimer’s diagnosis as well as markers to discern between Alzheimer’s and other types of dementia,” explains Paige. Some tests, such as anti-amyloid therapy, can be used to monitor a patient’s response to therapy.

Other tests, like the APO-E genotype, can assess genomic risks for Alzheimer’s. “This can predict a general risk for Alzheimer’s disease and direct specific lifestyle modification recommendations to mitigate risk,” Paige says. “A few more precise polygenomic risk assessment tests have been developed but have not received widespread clinical use due to cost and lack of insurance / Medicare coverage.”

He explains that Prodromescan, a blood test to evaluate biomarkers, can also guide nutritional supplementation, while imaging studies like CT scans and MRIs can suggest, but not usually definitively diagnosed, Alzheimer’s. A PET scan is more commonly paired with traditional CT and MRI scans to diagnose Alzheimer’s disease.

Tse highlights the particular value these advancements offer to high-risk populations. The development of a blood test that measures beta-amyloid levels is a less invasive and more accessible approach to early Alzheimer’s detection. “For high-risk populations, like those often overlooked in healthcare settings, including people of color and LGBTQ+ individuals, these advancements are pivotal,” says Tse. “From my perspective as a psychotherapist, supporting individuals with Alzheimer’s includes focusing on culturally competent care, which is increasingly viable as diagnostic tools become more accessible. Identifying early changes allows us to tailor therapeutic interventions to better support patients and their families, integrating mental health care into their overall treatment plan.”

How Memory Care Programs Can Best Support Residents with Alzheimer’s

As Alzheimer’s diagnosis and treatment evolves, memory care programs can play a key role in ensuring residents receive the care they need, especially in areas facing neurologist shortages. “The development of standardized evaluation and management models that can be implemented by mid-level providers will be necessary to cover the volume of individual patients and families impacted by cognitive decline diagnosis,” says Paige.

Tse says that it’s vital for memory care programs to integrate mental health support early in the care process. That involves training staff to recognize and respond to the mental health needs of residents with dementia. “Utilizing the available blood test to measure beta-amyloid levels can aid in identifying residents who might need more immediate care and intervention,” she says. “By incorporating these strategies, memory care programs can better support their residents despite the shortage.”

Looking Forward

The neurologist shortage poses a significant challenge to ensuring memory care patients get the diagnoses and support they need. At the same time, though, new and exciting advancements in Alzheimer’s diagnostic and treatment methods enable early and accurate detection and personalized support, giving hope for improved care.

“This increased accessibility can transform patient care by allowing earlier therapeutic interventions and customized care plans,” says Tse. “I anticipate that these advancements will enable us to integrate mental health strategies more effectively into dementia care plans, offering culturally sensitive support tailored to diverse populations. Early detection becomes a cornerstone, making it feasible for us to provide comprehensive care that genuinely addresses the needs of individuals and their families, thus enhancing the overall quality of life.”

Paige Cerulli

Paige Cerulli is a contributing writer to i Advance Senior Care.