Perspectives of patients, care partners, and primary care physicians on management of mild cognitive impairment and mild Alzheimer’s disease dementia

ABSTRACT

Objectives

Early diagnosis of mild cognitive impairment (MCI) and mild Alzheimer’s disease (AD) dementia is crucial for effective disease management and optimizing patient outcomes. We sought to better understand the MCI and mild AD dementia medical journey from the perspective of patients, care partners, and physicians.

Methods

We conducted online surveys in the United States among patients/care partners and physicians in 2021.

Results

103 patients with all-cause MCI or mild AD dementia aged 46–90 years, 150 care partners for someone with all-cause MCI or mild AD dementia, and 301 physicians (101 of which were primary care physicians, [PCPs]) completed surveys. Most patient/care partners reported that experiencing forgetfulness (71%) and short-term memory loss (68%) occurred before talking to a healthcare professional. Most patients (73%) followed a common medical journey, in which the initial discussion with a PCP took place 15 months after symptom onset. However, only 33% and 39% were diagnosed and treated by a PCP, respectively. Most (74%) PCPs viewed themselves as coordinators of care for their patients with MCI and mild AD dementia. Over one-third (37%) of patients/care partners viewed PCPs as the care coordinator.

Conclusions

PCPs play a vital role in the timely diagnosis and treatment of MCI and mild AD dementia but often are not considered the care coordinator. For the majority of patients, the initial discussion with a PCP took place 15 months after symptom onset; therefore, it is important to educate patients/care partners and PCPs on MCI and AD risk factors, early symptom recognition, and the need for early diagnosis and treatment. PCPs could improve patient care and outcomes by building their understanding of the need for early AD diagnosis and treatment and improving the efficiency of the patient medical journey by serving as coordinators of care.

Plain Language Summary

Alzheimer’s disease (AD) is not a normal part of aging, but many people develop AD as they age, and it is the seventh leading cause of death in the US. AD is a neurological condition that begins as mild cognitive impairment (MCI) or mild AD dementia. To understand the medical journey of patients with MCI or mild AD dementia, we surveyed 103 patients with MCI or mild AD dementia, 150 care partners, and 301 doctors. Patients had several symptoms before talking to a doctor, including forgetfulness and short-term memory loss; most patients (64%) first discussed these symptoms with a primary care physician (PCP) on average 15 months later. However, most patients were not diagnosed or treated by a PCP for MCI or mild AD dementia. We asked patients/care partners who they believe is the coordinator of their care for MCI and mild AD dementia. Thirty-seven percent felt the PCP was the coordinator of care. Most surveyed PCPs (74%) considered themselves to be the coordinator of care for their patients with MCI or mild AD dementia. In conclusion, PCPs play a key role in the care of patients with MCI and mild AD dementia. It is important for patients and care partners to understand the symptoms of MCI and mild AD dementia, and the need to get a diagnosis and treatment soon after symptoms appear. PCPs can play an important role in early diagnosis and treatment and serve as coordinators of care for their patients with MCI and mild AD dementia.

KEYWORDS:

• Alzheimer Disease
• cognitive dysfunction
• cardiovascular diseases
• physicians, primary care
• cross-sectional studies

Acknowledgments

The authors thank Rebecca Hahn and Elizabeth Tanner of KJT Group, Inc., Rochester, NY for providing medical writing support, which was funded by Novo Nordisk Inc., Plainsboro, NJ in accordance with Good Publication Practice (GPP3) guidelines.

Declaration of financial/other relationships

S Brunton has received consulting fees from Acadia and Novo Nordisk; and is also on the speakers’ bureau for Novo Nordisk. J Pruzin has received grants from the Arizona Alzheimer’s Disease Research Center for a research project involving cardiovascular disease, APOE, and blood biomarkers in autosomal dominant Alzheimer’s disease; he is the recipient of an Alzheimer’s Association Clinician Scientist Fellowship award examining physical activity, cardiovascular risk and their influence on AD. S Alford, C Hamersky and A Sabharwal are employees and shareholders of Novo Nordisk Inc. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

S Brunton, J Pruzin, and G Gopalakrishna interpreted the data included in the manuscript and critically revised each draft. S Alford, C Hamersky, and A Sabharwal contributed to the design and conduct of the study, interpreted the data included in the manuscript, and critically revised each draft. All authors had access to the study data, decided where to submit the manuscript, and approved the final version for publication.

Data availability statement

The underlying dataset discussed in this manuscript is proprietary and will not be posted publicly. However, the data can be made available to researchers upon reasonable request to the corresponding author.

Supplemental data

Supplemental data for this article can be accessed online at https://doi.org/10.1080/00325481.2023.2217025

Additional information

Funding

Novo Nordisk Inc. funded the study and writing support, and had a role in the study design, data collection, analysis, interpretation of data, and review/approval of the manuscript.