Alzheimer's Diagnosis More Likely In Berkeley Than Nearby

BERKELEY, CA — People who live in Berkeley are more likely than residents of some neighboring Bay Area communities to receive an early diagnosis of dementia or Alzheimer’s disease, according to a new study assessing regional disparities in diagnostic services.

Likewise, one location in the Bay Area was higher than Berkeley and surrounding East Bay cities.

The researchers cannot say for certain if the variation reflects an underdiagnosis or an overdiagnosis of dementia.

The findings of the study, published in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, suggest that the chance of being diagnosed may be more about the health system than about individual factors that affect dementia risk.

In fact, the researchers found, the same person would have as much as twice the chance of getting a dementia diagnosis in some areas of the country as in others.

“The message is clear: from place to place, the likelihood of getting your dementia diagnosed varies, and that may happen because of everything from practice norms for health care providers to individual patients’ knowledge and care-seeking behavior,” Dr. Julie Bynum, a professor of internal medicine and geriatric and palliative medicine at the University of Michigan Medical School, said in a news release.

“But the good news is,” Bynum continued, “these are things we can act on once we know where to look.”

A CNN analysis of Medicare claims data for 4.8 million older adults across 306 hospital referral regions shows ZIP Code-level differences within a single state. The researchers developed a novel measure called “ADRD-specific diagnosis intensity” to compare actual diagnosis rates in each region to what would be expected based on population risk factors.

In California, no regions were in the highest designation. Residents of the North Bay were more likely to get a timely Alzheimer's or dementia diagnosis, while coastal residents north of Marin and in the Monterey Bay Area were less likely to receive a diagnosis.

Researchers said that not only does the percentage of people who get a new dementia diagnosis each year vary greatly across regions of the country, the disparities are even greater for people at the young end of the dementia-risk age range, ages 66 to 74, and for those who are Black or Hispanic.

Bynum and her colleagues at U-M and the Dartmouth College Geisel School of Medicine studied Medicare claims data of 4.8 million people over the age of 66 in 2019. Researchers said that while nearly 7 million Americans currently have a diagnosis of dementia, millions more likely have symptoms but no formal diagnosis, the researchers said.

The new study demonstrates for the first time that regional diagnostic differences are not explained by variations in the dementia risk levels of different populations.

The researchers also noted the variation could stem from cultural or personal differences in how likely a person is to seek health care of any kind, to schedule an appointment specifically for memory concerns, to mention memory problems, or to think proactively about health care without being prompted during an existing appointment.

However, they did say areas with lower-than-expected diagnosis rates for dementia could use the new findings to identify barriers that may hinder early diagnosis.

For example, Bynum explained, changes in clinical practices could increase the number of times people are screened by their primary care physician for early signs of dementia, or the availability of specialists to make a confirmed diagnosis.

“The goal these days should be to identify people with cognitive issues earlier, yet our data show the younger age group of Medicare participants is the one with the most variation,” Bynum said in the news release. “For communities and health systems, this should be a call to action for spreading knowledge and increasing efforts to make services available to people. And for individuals, the message is that you may need to advocate for yourself to get what you need, including cognitive checks.”