this post was submitted on 22 Nov 2023
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I see this in my office constantly and there are lots of reasons surrounding it. All of my patients get a mini mental status exam (MMSE) with their yearly physical after age 65.The ones with any impairment tend to deny it as real. If there is impairment, I try to work it up with labs and then a brain MRI. Insurance won't cover a brain MRI for MCI, so it has to be coded as "memory loss". Memantine and donepizil are not indicated for MCI, just dementia, so we don't prescribe them that early. We wait until it progresses. Also, I've seen a ton of patients over the years who have "microvasular changes" on brain imaging done for other reasons that no one has discussed with them, much less actually done an appropriate cognitive assessment and further workup. I don't know why I am such an outlier in these areas, because I'm not doing things that aren't indicated by specialty recommendation. I think it's just another sign of our broken system.
Any suggestions for someone with a parent who openly acknowledges that he's having cognitive changes / difficulties? I get the sense he's experiencing precisely this kind of pre-dementia decline. He's on Medicare, FWIW. I just assumed nothing was realistically available (thanks, US healthcare system for the deep sense of futility), but would love to be wrong.