Worsening Memory or Confusion After 45: Who Reports It, and Who Tells a Doctor

Subjective cognitive decline is a person's own sense that memory loss or confusion is getting worse or happening more often. It can be an early symptom of dementia, including Alzheimer disease or a related dementia, the most common of which, Alzheimer disease, affects an estimated 6.5 million Americans aged 65 and older. That number is projected to double by 2060, with the largest increases among Black and Hispanic adults. Known risk factors that can be changed include high blood pressure, too little physical activity, obesity, diabetes, depression, smoking and hearing loss.

This CDC report used the Behavioral Risk Factor Surveillance System, a telephone survey of adults. Every state, D.C. and Puerto Rico asked its cognitive decline questions of adults 45 and older at least once between 2015 and 2020, and the most recent year for each was pooled — 215,406 people in all. Anyone who said they had had worsening or more frequent confusion or memory loss in the past 12 months was asked whether they had discussed it with a health professional.

Who reports it

Overall, 9.6% of adults aged 45 and older reported subjective cognitive decline. By race and ethnicity (age-adjusted):

The rates among American Indian/Alaska Native and Hispanic adults were significantly higher than among White adults, and the rate among Asian/Pacific Islander adults lower; Black and White adults were similar. The pattern held across most subgroups.

• It rose with age, reaching 13.3% at 75 and older.
• It fell with education: 16.4% among people without a high school diploma, and lower among college graduates in every racial and ethnic group — consistent with research linking more education to lower dementia risk.
• It was 13.6% among adults who had been married but no longer were, and lower among the insured (9.5%) than the uninsured (11.6%).
• By state, it was highest in Alabama (14.3%), Oklahoma (14.1%), Florida, Louisiana and West Virginia (each 13.6%), Tennessee (12.9%) and New Mexico (12.8%), and lowest in Illinois (6.1%).

Few tell a doctor

Of 21,299 people who reported the problem, only 47.3% had talked with a health professional about it — 50.7% of women and 43.3% of men. Those least likely to have done so were 75 or older, had less education, had no health insurance or personal doctor, or had not seen a doctor in the past year.

Why it matters

Talking to a doctor about changes in thinking can uncover conditions that are treatable, detect dementia early, prompt steps to reduce risk, and lead to a care plan that helps people stay healthy and independent longer. Early diagnosis can also prevent costly, avoidable hospital stays — important since some people with cognitive decline are themselves caring for others.

• Ask earlier. Providers could ask patients from age 45 about worsening memory or confusion.
• Widen access. Medicare's Welcome to Medicare visit and Annual Wellness Visit cover cognitive assessment for adults over 65; people without routine care need other routes.
• Reduce risk. For some people, dementia can be delayed or made less likely through heart-healthy living, protecting the head from injury, and staying socially active.

Under the BOLD Act (Building Our Largest Dementia Infrastructure), CDC is strengthening public health work on dementia and caregiving, through BOLD Public Health Centers of Excellence, the Healthy Brain Initiative Road Map and programs such as the Chronic Disease Self-Management Program.

Limitations

Some groups were too small for state-level comparisons; the survey leaves out people living in institutions; and self-reports can be affected by memory, the wish to give acceptable answers and cultural differences — though people's own sense of decline has been shown to distinguish early Alzheimer-related changes from normal aging.

Sources

• Wooten KG, McGuire LC, Olivari BS, Jackson EMJ, Croft JB. "Racial and Ethnic Differences in Subjective Cognitive Decline — United States, 2015–2020." MMWR 72(10). CDC.