Cognitive Concerns in Primary Care: 10 Things You Should Know

This just in: Medicare reimburses physicians 3 to 5 times more for common procedural care than for cognitive care. A few hours of time spent on 2 common specialty procedures-colonoscopy and cataract extraction-can generate more revenue than a primary care physician receives for an entire day’s work.

Researchers suggested that the health care system continues to provide financial rewards to physicians for “doing things” to patients rather than talking with them and managing those who have chronic illnesses.

More than 16 million persons in the United States have cognitive impairment. An estimated 5.1 million Americans aged 65 years or older may have Alzheimer disease, and this number may rise to 13.2 million by 2050.

So although procedural time gets better pay than time spent on cognitive care, the need for the latter will continue to grow as the numbers of patients with problems increase.

To keep up on cognitive disorders, consider these facts and figures:

1. Urinary protein levels may be an early marker of future cognitive decline in patients with type 2 diabetes (DM) and normal kidney function. The risk of cognitive impairment is 50% to 100% higher in persons who have DM than in those who do not.

2. Lowering blood sugar levels is a promising strategy for preventing memory problems and cognitive decline as persons age, even for those whose blood sugar levels fall within the normal range.

3. Heart disease and stroke risk prediction tools may be more useful in predicting cognitive decline in middle-aged patients than a dementia risk test.

4. Moderate to high alcohol intake is associated with an increased incidence of atrial fibrillation (AF). Mild cognitive impairment is highly prevalent in older high-risk patients hospitalized with AF, and it may result in more disability and morbidity than the AF itself.

5. Cognitive processes that relate to verbal fluency are compromised in persons with insomnia despite the absence of a behavioral deficit. These specific brain function alterations can be reversed through nonpharmacological treatment with 6 weeks of sleep therapy.

6. Primary care physicians should be alert to the possibility of cognitive dysfunction in patients with prolonged exposure to antiretroviral therapy.

7. Functional MRI demonstrated changes in brain function and cognitive performance in patients with relapse-remitting multiple sclerosis (MS) after they participated in a cognitive rehabilitation program. Along with many physical symptoms, MS can cause memory loss and other cognitive effects.

8. A small jar of peanut butter and a ruler may turn out to be an inexpensive, sensitive, and specific olfactory means of screening for early Alzheimer disease.

9. Fibromyalgia syndrome may slow the brain somewhat, but the cognitive problems known as “fibrofog” do not represent the onset of gradually increasing dementia or resemble early Alzheimer disease.

10. Patients in medical and surgical ICUs are at high risk for long-term cognitive impairment. Of the 821 patients enrolled in a recent study, 6% had cognitive impairment at baseline and delirium developed in 74% during the hospital stay. Deficits occurred in both older and younger patients and persisted.