Early Detection and Diagnosis
Early detection, a core public health strategy, is essential to providing access to information, care and support to people living with Alzheimer's and other dementia. Many people living with Alzheimer's are not diagnosed. Even among those who are, a large number are unaware of their diagnosis. An early diagnosis, though, can improve the quality of care and quality of life and may reduce the financial and emotional impact of the disease.
For an overview of these issues, and other related topics:
- Early Detection and Diagnosis of Alzheimer's Fact Sheet (PDF).
- Ensuring Early Detection and Diagnosis Issue Map (PDF).
Learn how public health can advance early detection and diagnosis by educating the public and health care providers.
Educating the public
Individuals must feel comfortable discussing concerns about their thinking and memory with their health care providers. This requires addressing barriers to such conversations. Barriers include not knowing the warning signs of cognitive impairment, misperceptions about Alzheimer's and other dementias, and community and family stigma associated with an Alzheimer's diagnosis.
What public health can do
Public health agencies can educate people of all ages about cognitive health, the benefits of early detection, and when to discuss concerns with a health care provider. Specifically, these public awareness efforts should target:
- Awareness about cognitive health and changes in thinking or memory that call for a conversation with a health care professional.
- Shifting mindsets and normalizing discussions about cognitive health in routine health care.
- The advantages of receiving a formal diagnosis, including access to treatments that help with symptoms, time to build a care team, and the opportunity to specify care and legal plans for the future.
- Reducing stigma and myths surrounding Alzheimer's and other dementias.
State success: Educating the public in Georgia
The Georgia Department of Public Health developed and conducted a public awareness campaign — Think About It. The campaign educated the public about cognitive health, encouraged individuals experiencing cognitive concerns to talk to a health care provider, and provided tools for clinicians to identify warning signs and how to utilize the cognitive health benefit of Medicare's Annual Wellness Visit. The campaign was promoted through public transit ads.
Educating health care providers
While the benefits of early detection are numerous and well-established, clinicians face obstacles that hinder early detection and diagnosis. Barriers include:
- Lack of education on the signs of cognitive impairment.
- Limited education or training on dementia care.
- Concerns about stigma and the usefulness of an early diagnosis.
- Confusing cognitive impairment with conditions that may mimic dementia (including delirium, certain vitamin deficiencies and depression).
- Lack of time.
- Difficulty talking about dementia or disclosing a diagnosis.
What public health can do
Health care providers often turn to public health agencies for help understanding the latest research, best practices and emerging evidence on a number of health topics — including cognitive impairment and dementia. Public health officials can ensure that health care providers stay current with necessary education and training needed to properly assess cognitive impairment and compassionately disclose a diagnosis. Important areas for provider education include:
- Early detection, diagnosis, documentation of diagnosis, disclosure of diagnoses, and care of dementia.
- The Medicare Annual Wellness Visit's cognitive assessment provisions, reimbursement for comprehensive care planning (via CPT® code 99483), and the availability of community services and support after a diagnosis.
- Tools and resources available to help providers detect and diagnose cognitive impairment as early as possible. Resources include:
- The KAER Approach to Cognitive Impairment toolkit developed by the Gerontological Society of America.
- Online training by the Health Resources and Services Administration about Alzheimer's disease, provider education and dementia caregiving.
- Disparities in risk for and diagnoses of cognitive impairment and of appropriate clinical monitoring among some populations.
Learn more with additional early detection and diagnosis resources, including:
- Issue Brief on Early Detection and Diagnosis of Alzheimer's (PDF).
- 10 Early Signs of Alzheimer's.
- Medicare Annual Wellness Visit Fact Sheet (PDF).
- Earlier Diagnosis.
- Information for Health Systems and Clinicians.
- Diagnosing Alzheimer's: The Case for Public Health Action (Webinar).
State successes: Educating health care providers in Hawaii and California
The Hawaii Director of Health sent a “Dear Colleague” letter (PDF) to physicians encouraging early detection and diagnosis, including through the use of the Medicare Annual Wellness Visit benefit.
The California Department of Public Health (CDPH) created the Assessment of Cognitive Complaints for for Alzheimer's Disease (ACCT-AD) to provide primary care providers with the tools and training necessary to recognize normal cognition, diagnose Alzheimer's disease, and identify other cognitive problems requiring speciality referral. CDPH promotes the toolkit to providers statewide, including webinars on the importance of the toolkit and what it aims to accomplish.
| AL | Alabama Department of Public Health | Alabama Department of Public Health had one of its divisions, Alabama Public Health Training Network, conduct a webcast for public health professionals about Alzheimer’s basics, with a free CEU available for state employees. Nearly 200 people participated. |
| AZ | Banner Alzheimer's Institute | The Banner Native American Outreach program increases awareness of Alzheimer's and other dementias among Arizona's American Indian communities, and works to establish better connections among tribal health organizations and urban Indian communities. |
| CA | Department of Public Health | In FY2017, California Department of Public Health provided new funding to the state’s Alzheimer’s disease centers for targeted outreach to health professionals to increase early detection and diagnosis, in part through provision of tools. |
| CO | Colorado Department of Public Health and Environment | Trained nearly 100 first responders how to effectively interact with people living with dementia, and created and distributed the workplace poster, Tips for EMS Working with People with Alzheimer’s to remind trainees of best practices. |
| GA | Georgia Department of Public Health | Georgia Department of Public Health developed and distributed a public awareness campaign — Think About It — through transit ads on buses, trains, and billboards. Campaign educates the public and providers about cognitive health. |
| GA | Georgia Department of Public Health | Department of Public Health trained clinical staff (70 physicians and 75 nurse practitioners) about dementia and the need for increased awareness and diagnosis. |
| HI | Hawaii State Department of Health | Through the Hawaii Alzheimer's Disease Initiative (HADI) — a collaboration of state agency and community partners — established a dementia speakers bureau to provide education to caregivers and the community |
| HI | Department of Health | Adapted existing print materials that encourage people to talk to health care professionals about memory problems, then disseminated the materials for placement in doctors’ offices. |
| IA | Department of Public Health | Healthy Iowans includes delivery of Medicare annual wellness visits in progress report which includes assessing cognitive function |
| IL | Illinois Department of Public Health | Developed and deployed dementia-specific training for all direct care workers in residential settings, and in home- and community-based settings. IL DPH hosts training and monitors compliance across the state. |
| IL | Illinois Department of Public Health | The Illinois Department of Public Health partnered with the Illinois Public Health Association to conduct a webinar with continuing education units to educate public health professionals about the role of local public health agencies in promoting early detection and diagnosis of Alzheimer’s and other dementias. |
| KS | Kansas Department of Health and Environment | Raised awareness of Alzheimer's and early warning signs through a three-month targeted social media campaign, using the Alzheimer's Association "Know the 10 Signs" video campaign. Through evaluation, learned that future outreach would best reach Kansans aged 35-44, 65+, and women aged 55-64. |
| KS | Kansas Department of Health and Environment | Increased public awareness of risk reduction messages to enhance early detection and reduce stigma via a partnership with the Kansas State Extension Office; trained almost 50 Extension Officers to educate Kansans about Alzheimer’s and brain health in counties across the state. |
| LA | Louisiana Department of Health | Educated LDH supervisors about workplace support for caregivers (especially employees caring for people living with dementia); the online training module is available to supervisors in all state agencies, and Louisiana social workers can receive continuing education for successful completion of the module. |
| ME | Department of Health and Human Services | Distributed the State Plan for Alzheimer’s Disease and Related Dementias in Maine – a special insert for health care providers on cognitive assessment tools, early detection, and the value of early diagnosis – to primary care professionals through hospital and health systems. |
| MN | Minnesota Department of Health | Educated community health workers on the oral health needs of people living with Alzheimer’s and other dementias by developing a curriculum and partnering with institutions that train these workers. |
| MN | Department of Health | With legislative support, Minnesota Department of Health created new program focused on providing outreach and dementia education to African-Americans, African-born residents, and Asian and Hispanic populations. |
| MO | Missouri Department of Health and Social Services | Enhanced public awareness of cognitive health and dementia among African Americans in the southeast region of Missouri by conducting a multi-faceted social marketing campaign that provides culturally appropriate messaging and information on risks, early diagnosis, treatment, and community resources. |
| MO | Missouri Department of Health and Social Services | Promoted cognitive assessments and early diagnosis in partnership with Washington University and the existing Community Health Worker Advisory Body through incorporation of these topics into existing community health worker programs for diabetes, cardiovascular health, and women’s health. |
| MT | Montana Department of Public Health and Human Services | In monthly newsletter — Health in the 406 — Montana Department of Public Health and Human Services included cognitive health including how to recognize early warning signs, how to access services, and where to find more information. |
| MT | Montana Department of Public Health and Human Services | Medical Director sent a "Dear Colleague" letter about the benefits of early detection and diagnosis to the Nurses Association, Medical Association, and Hospital Association. |
| NE | Nebraska Department of Health and Human Services | Nebraska Department of Health and Human Services distributed early warning signs and resources for people with cognitive concerns to 120 LivingWell program leaders statewide |
| NJ | New Jersey Department of Health | Department of Health, Office of Minority and Multicultural Health partnered with the Alzheimer's Association to conduct a brain health event in conjunction with African-American Brain Health Initiative (AABHI) and Rutgers University-Newark. AABHI promoted healthy aging among older African Americans at the Newark Classic Car Show (April 2017) by teaching older men about brain health, potential ways to reduce the risk of cognitive decline, and how to participate in aging research at RU-Newark. |
| NM | New Mexico Department of Health | Educated the public about ways to protect brain health by developing three PSAs based on the Alzheimer’s Association’s 10 Ways to Love Your Brain campaign; PSAs began airing on local TV station in fall 2017 and have been adapted for other media markets. |
| NM | New Mexico Department of Health | Improved support for caregivers of people living with dementia by co-marketing chronic disease self management courses and caregiving education programs; initial outreach resulted in more than 150 caregiver-participants. |
| NY | New York State Department of Health | The New York State Health Commissioner sent a November 2016 ‘Dear Colleague’ letter, encouraging health care providers to “play their part in the early detection/diagnosis of Alzheimer’s Disease and other dementias.” The letter highlights dementia prevalence data and various resources, including the NYS Alzheimer’s Disease Support Initiative |
| NY | New York State Department of Health | New York State Department of Health partnered with University of Albany to provide free CME online training for primary care physicians, along with informational resources and tools. |
| OR | Aging and Disability Resource Center (ADRC) of Oregon | To promote early detection of Alzheimer’s disease among Hispanic populations, the Aging and Disability Resource Center (ADRC) of Oregon adapted an English-language fotonovela -- an educational tool with photos and a story narrative -- for Spanish-language communities. Involvement of promotoras enhanced cultural relevance. The Alzheimer's Association, Oregon Chapter, the Oregon Health Authority, and many other partners now promote and distribute the fotonovela to Spanish-speaking communities, in part through public health networks. |
| OR | Oregon Health Authority | Aging and Disability Resource Connection of Oregon published ¡Unidos Podemos! Enfrentando la pérdida de memoria en familia, a fotonovela for Spanish-speaking community members on caring for loved ones with Alzheimer’s disease. The Oregon Department of Human Services, Alzheimer's Association Oregon Chapter, and Oregon Health Authority now promote and distribute the fotonovela to Spanish-speaking communities and public health networks. |
| PR | Departamento de Salud | Created and promoted a 6-CME/CEU educational module, Alzheimer’s Disease: Early Detection and Diagnosis, for physicians, nurses, psychologists, health educators and social workers. |
| RI | Rhode Island Department of Health | Established a new program — Alzheimer's Disease and Related Disorders — within the Rhode Island Department of Health to better assess and track state progress on risk reduction of cognitive decline and meeting the needs of people with dementia. |
| SC | South Carolina Department of Health and Environmental Control | South Carolina Department of Health and Environmental Control worked with the Alzheimer’s Association South Carolina Chapter to distribute 48,000 of the association’s Know the 10 Signs brochures through its regional offices to raise awareness, especially among African Americans. |
| TN | Tennessee Department of Health | Educated public health professionals about cognitive health, health indicators, diagnosis, and community resources via an issue brief developed from original data analyses and conducted a live training webinar to discuss findings and implications for public health practice. |
| TX | Texas Department of State Health Services | Texas Department of State Health Services is developing a print, social, and television ad campaign about risk reduction of cognitive decline and early warning signs. The campaign will focus on increasing early detection efforts among people individuals experiencing cognitive complaints |
| TX | Dallas County Public Health Department (TX) | Adapted and promoted a public service announcement to educate the public about brain health and ways to protect cognition. |
| TX | Harris County Public Health Department (TX) | Adapted and promoted a public service announcement to educate the public about brain health and ways to protect cognition. |
| TX | City of San Antonio | Published a column on Alzheimer’s disease in the local Spanish-language paper, with an emphasis on increasing awareness and promoting early detection and diagnosis. |
| UT | Utah Department of Health | Executive Director of the Department of Health sent a Dear Colleague letter to all health care providers licensed in the state, encouraging them to conduct cognitive assessments as part of the Annual Wellness Visit. The letter also provides links to community resources. |
| UT | Utah Department of Health | Promoted early detection and diagnosis of Alzheimer’s and other dementias by documenting cognitive assessment practices during Medicare Annual Wellness Visits; disseminated study findings to all Utah primary care physicians; and, distributed a list of resources for people with cognitive impairment along with a recommendation from UDOH’s executive director for routine cognitive screening during the Annual Wellness Visit. |
| UT | Utah Department of Health | Utah Department of Health featured Alzheimer’s and related dementias and their impact on the state in its May 2016 Monthly Health Status Update for public health professionals and stakeholders. |
| UT | Utah Department of Health | Utah Department of Health contracted with Health Insight (a quality improvement organization) to query primary care providers about current efforts and challenges related to assessing for cognitive impairment and caring for people with dementia. |
| WA | Washington State Department of Health | Implementing the Healthy Brain Initiative Road Map: A Toolkit for Public Health Organizations |
| WA | Washington State Depatment of Health | Washington State Department of Health participated on webinar about their whole agency approach to engage the entire agency on cognitive health, dementia, and caregiving |
| WA | Washington State Department of Health | Department of Health partnered with Northwest Regional Primary Care Association (NRPCA) to feature the NAPCA brief on Asian Americans/Pacific Islanders and early detection in the NRPCA newsletter for its network of community clinics. |
| WA | Washington State Department of Health | Educated African Americans about brain health by partnering with the Center for MultiCultural Health in Seattle; the Center identified African American churches as promising venues to speak about brain health and distribute hand fans with culturally-appropriate messages that promote brain health. |
| WA | Washington State Department of Health | With the National Asian Pacific Center on Aging, the Washington State Department of Health tested University of Pennsylvania media messages with Asian American adults who may have concerns about changes in their aging parents’ memory or cognition. |
| WI | Wisconsin Department of Health Services | Developed online training for family caregivers of people with Alzheimer’s disease or other dementia and provides a list of resources for caregivers |
| WI | Wisconsin Department of Health Services | Wisconsin Department of Health Services and a designated group of stakeholders, the University of Wisconsin Oshkosh (UWO), Center for Career Development and Employability Training (CCDET) is developing a series of free, online trainings related to dementia care for crisis responders, caregivers, healthcare providers, family and community members, and other professionals. A Spanish-language version is available. |
| WV | West Virginia Department of Health and Human Resources | Commissioner of Bureau for Public Health issues a "Dear Colleague" letter about the benefits of early detection and diagnosis of dementia and how provides can seek reimbursement for comprehensive care planning services for cognitive impairment — the letter was also published in the West Virginia Medical Journal titled " Alzheimer's and Other Dementias: A Community Health Issue" |