Formal Dementia Diagnosis Reduces Risk of Performing Unsafe Activities

If dementia goes undiagnosed, people with dementia run the risk of unsafe activities such as driving, cooking, and managing finances and medication, according to researchers at Johns Hopkins, who stress the need for formal diagnosis.

“When patients receive a formal dementia diagnosis, their families are typically aware that, at some point, their loved ones will not be able to drive or will need more help with their medicine,” said lead author Halima Amjad, MD, MPH. “But when people are undiagnosed, families and friends may ignore or be unaware of functional problems that already exist.”

Put simply, the study, published in the Journal of the American Geriatrics Society, emphasized that delaying or avoiding diagnosis for dementia is a risk not worth taking.

Study Design and Method

The primary purpose of the study is to understand the varying prevalence of potentially unsafe activities and living conditions in people with dementia as against people who probably don’t suffer from dementia.

The study population consisted of more than 7500 Medicare beneficiaries ages 65 and older. Participants were asked about potentially unsafe activities such as providing care to another person, driving, preparing hot meals, managing finances and medications, traveling alone to doctors' visits, or falling.

Study Results

The prevalence of potentially unsafe activities was lowest in participants with probable dementia as compared to the people with reported diagnosis.

The good news was that those with dementia—either diagnosed or undiagnosed—were engaging less frequently in potentially unsafe activities than those with possible or no dementia. For example, about 23% with probable dementia were driving, compared to 59% with possible dementia and 84% with no dementia.

“Either the patients themselves or their family members are self-regulating and doing these activities less frequently as their disease is progressing,” Amjad says.

However, the study also revealed a significant gap between those with formally diagnosed dementia and those with undiagnosed but probable dementia. For example, while about 17% of volunteers with diagnosed dementia were still driving, nearly 28% of those with undiagnosed dementia were doing so. Also, nearly 22% of the diagnosed were still handling their own medications, compared with around 50% of the undiagnosed.

Encourage More Formal Screenings

An estimated 5 million people in the United States have dementia. The numbers are projected to nearly triple by 2050. Dementia can affect the cognitive domain, including executive function, insight, and judgment. Over time, cognitive decline leads to increasing functional impairment and difficulty with basic activities of daily living.

The study highlights the importance of understanding older adults with potentially undiagnosed dementia. These individuals may be less functionally impaired, creating more diagnostic difficulty and perhaps less safety risk, but these findings show that this group has potentially significant cognitive impairment and difficulty with activities. As a result, there is a need for more formal screenings for dementia for elderly patients having difficulties with activities.

Active assessment of difficulty with activities may help identify older adults for whom dementia screening is warranted. It is possible that these individuals have a dementia diagnosis of which they are unaware or lack of acceptance of their condition, contributing to higher rates of potentially unsafe behaviors.

“Families are really the front line in recognizing when someone shouldn't be driving or needs more help with managing medicine,” Amjad said.