Discussion
Prevalence of SCD varied across adults by demographic characteristics and race and ethnicity. Among racial and ethnic groups, SCD was lowest among A/PI adults and highest among AI/AN adults. Prevalence of SCD was higher among persons with less formal education than among college graduates across all racial and ethnic groups. This finding is consistent with other studies that suggest that persons with more years of formal education have a lower risk for dementia than do those with fewer years of formal education.[5,6] Low prevalence of SCD among adults with higher education suggests that education might be protective against SCD. More research is needed to better understand the roles that education and related systemic factors play in sustaining cognitive health, particularly across diverse racial and ethnic populations. For example, modifiable risk factors for ADRD are less prevalent among adults with higher education, differ among racial and ethnic groups, and are associated with high prevalence of SCD.[2]
The findings of this study can help health care providers identify groups of patients who would benefit from risk reduction behaviors and further cognitive assessment. Persons who talked with a health care professional about SCD were more likely to be women, had at least some college education, were aged <75 years, had a personal doctor, had a doctor visit within the past year, and had health insurance. Public health strategies are needed to support access to health care for persons who lack access to routine health care or to have a designated preventive health care professional. For example, programs such as Welcome to Medicare§§ and Medicare Annual Wellness Visit for adults¶¶ aged >65 provide coverage for preventive care screenings including cognitive assessments. Health care providers could consider asking patients as young as age 45 years about experiences of worsening memory loss or confusion during visits to initiate discussions about early signs of dementia and strategies to reduce risk and sustain cognitive health.
The findings in this report are subject to at least three limitations. First, sample sizes for some racial and ethnic groups were too small to detect statistical differences, particularly at the state level. Second, BRFSS represents the noninstitutionalized adult population only and therefore cannot be generalized to institutionalized adults. Finally, BRFSS data rely on self-report rather than medical examination records; survey questions about cognitive decline may be subject to recall and social desirability biases and responses may reflect cultural differences. However, the self-perception of cognitive decline has been shown to discriminate preclinical ADRD from normal aging.[7]
Early detection and diagnosis are important to rule out conditions other than ADRD that might be treatable, and to establish a care plan to manage co-morbid conditions and avoid unnecessary hospitalizations. These potentially avoidable hospitalizations can be both costly and detrimental to quality of life, especially given that some persons with SCD are caregivers for others, which might affect the quality of care provided.[8] Public health professionals can continue working to improve social determinants of health, conditions in places where people are born, live, learn, work, play, worship, and age that affect risk for developing ADRD.[9] Although dementia might not be preventable for some, the risk for developing dementia for others can be delayed or reduced through early interventions and public health education including heart-healthy lifestyles, protecting the head from traumatic brain injury, and engaging in social activities.[1,2,10] The Building Our Largest Dementia Infrastructure Act (BOLD), charges CDC with strengthening the dementia and dementia caregiving public health infrastructure.*** BOLD Public Health Centers of Excellence on Risk Reduction, Early Detection, and Caregiving are national resources to public health departments in reaching populations at greatest risk for ADRD and their caregivers. States and organizations participating in the National Healthy Brain Initiative and BOLD Public Health Programs††† are strengthening the public health infrastructure utilizing the Healthy Brain Initiative Road Map Series§§§ and implementing strategies for reducing dementia in populations with known and widening disparities through programs such as the Chronic Disease Self-Management Program.¶¶¶ Public health professionals can use these strategies to reduce risks for dementia in at-risk populations within their jurisdictions.
Morbidity and Mortality Weekly Report. 2023;72(10):249-255. © 2023 Centers for Disease Control and Prevention (CDC)
