Where you live can have a major impact on whether or not you get a timely diagnosis of dementia, a new study finds. The study, published in Alzheimer's & Dementia: The Journal of the Alzheimer's Association, found that you can have twice as much likelihood of receiving a dementia diagnosis in some parts of the U.S. than you would in others.

The study was led by Julie Bynum, M.D., M.P.H., a professor at the University of Michigan Medical School. Dr. Bynum and her colleagues conducted the research using data from the records of 4.8 million people who were covered by traditional Medicare and over the age of 66 in 2019.

How the Study was Conducted

The study looks at diagnoses within each of 306 hospital referral regions. Each region includes at least one hospital capable of doing advanced heart surgery and brain surgery. The researchers specifically chose to use these regions because dementia diagnosis and advanced treatment also requires specialized services.

The researchers calculated the regional rates of new diagnoses of Alzheimer’s and other types of dementia for each region. The prevalence of diagnosed dementia ranged from as low as 4% to as high as 14% depending on the region, and the rate of new dementia diagnoses in 2019 ranged from 1.7% to 5.4%.

Researchers then looked at dementia rates for three age groups – 66 to 74, 75 to 84, and 85 and over – and for people of different races. They also included data about the percentage of the population in each region that had known risk factors for dementia, such as less than a high school education, cigarette smoking, and obesity or diabetes. Lastly, they incorporated information about the general intensity of all kinds of chronic disease diagnosis in each region. By taking these factors into account, the researchers were able to calculate what is known as “diagnostic intensity,” or a predicted rate of diagnosis for new and total Alzheimer’s and dementia cases for individuals in each region.

Here are some of the findings:

• Your chance of being diagnosed may be more about the location of your health system than about individual factors that affect dementia risk.

• While nearly 7 million Americans currently have a diagnosis of dementia, millions more likely have symptoms but no formal diagnosis. A formal diagnosis is critical, as it is a requirement for access to advanced new tests and treatments for dementia, many of which can slow down the progression of dementia only when the dementia is diagnosed in its earliest stages.

• Overall, about 7% of people covered by traditional Medicare have a dementia diagnosis at any given time, and 3% of this population is diagnosed each year, with an average age at diagnosis of about 83.

• Rate of new dementia cases identified varies geographically across the United States.

• The likelihood of you receiving a dementia diagnosis varies 2-fold based on where you live.

• Geographically, the highest concentration of diagnosed dementia cases was in the southern U.S. Some of the regions in this area are part of the “stroke belt,” a region in the southeastern U.S. that has the highest risk for stroke and cardiovascular disease. The 11 states that comprise the stroke belt are Alabama, Arkansas, Georgia, Indiana, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, and Virginia.

• The differences between regions of the country are even larger if you’re on the younger end of the dementia-risk age range, age 66 to 74, or Black or Hispanic.

• The study stated that differences in diagnosis by region aren’t explained by differences in the dementia risk level of different populations.

Scientists believe that areas with lower-than-expected diagnosis rates for dementia could use these findings to look at what barriers might stand in the way of someone getting diagnosed. “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,” Dr. Bynum said. “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.”

Dr. Bynum urges you to use your annual wellness benefit, as Medicare covers a cognitive screening during each enrollee’s annual wellness visit. She also notes that the recent launch of Medicare’s GUIDE model for dementia care may offer a path to improving care. She believes that “(t)he model incentivizes clinical practices to coordinate dementia care better and offer around-the-clock access to a trained provider.”

Early Diagnosis is of Utmost Importance

As stated, a confirmed diagnosis of dementia can be very important for accessing specialized care and support for you and your family members or friends who act as caregivers. Education and support can assist you and your family family in finding the best treatments and avoiding harmful and unnecessary treatments. You and your family can learn to manage symptoms, and plan for the future by establishing estate planning, incapacity planning, and long-term care planning documents.

If you or someone in your family has dementia, you face special legal and financial needs. For this reason, it is important to find an experienced elder law attorney who is dedicated to easing the financial and emotional burden on those suffering from dementia and their loved ones. Life Care Planning and Medicaid Asset Protection is important to protect your family’s hard-earned assets while maintaining your comfort, dignity, and quality of life by ensuring eligibility for critical government benefits such as Medicaid and Veterans Aid and Attendance.