5 Challenges Physicians Face When Screening for Cognitive Decline

Patient-related Barriers: “Many patients do not want to know about their condition, they’re in denial. There is also stigma attached to accepting help even if the patient does acknowledge cognitive decline.”

• Denial or lack of insight: Many patients are in denial about cognitive decline, resist clinical evaluation, or are unaware of their own deficits.
• Refusal of or resistance to diagnosis and treatment: Patients often decline further evaluation, treatment, or even referrals to specialists.
• Lack of social input or isolation: When a patient lives alone or without close social contact, physicians are limited in their ability to gather accurate histories or track a decline over time.
• Unrealistic expectations: Patients expect multiple complex issues to be addressed in a single visit, underestimating the time and evaluation needed for cognitive concerns.

Time Constraints in Primary Care: “An average office visit is too short to initiate and complete an average cognitive assessment and provide appropriate counseling.”

• Limited visit time: Physicians cite insufficient time to conduct thorough cognitive assessments during standard office visits.
• Time-consuming referral process: Delays in scheduling a specialist appointment and prolonged testing timelines hinder timely diagnosis and intervention.
• Poor appointment structuring: Inefficiencies in EHR scheduling systems limit clinicians’ ability to structure effective visits to address cognitive complaints.

System Level and Resource Limitations: “There is a significant lack of specialists in neurology and psychiatry for timely referrals, even when the patient is willing to go for the follow-up.”

• Inadequate specialty access: Difficulty in referring patients to neurology or obtaining neurocognitive testing.
• Lack of community resources and social support: Poor availability of caregiver support, social services, and memory care facilities.
• Stigma and societal resistance: Both patients and families may be reluctant to seek or accept help due to societal stigma an/or misunderstanding of dementia.

Clinical Challenges and Uncertainty Remain: “As of now, there is no official guidance on the approach to assessment of early cognitive decline and the available drugs are prohibitively expensive and have tolerability issues.”

Distinguishing dementia from mild cognitive impairment (MCI): Physicians struggle to differentiate early stages and determine when to initiate treatment.

• Lack of effective treatments: Frustration over the limited efficacy, side effects, and high cost of available medications.
• Confusion over guidelines and next steps: Uncertainty about best practices, diagnostic pathways, and follow-up procedures.
• Need for better tools: Desire for standardized templates and clearer frameworks for assessing and managing dementia in primary care.

Physicians Absorb Emotional Toll and Professional Strain: "It is really unsustainable to effectively manage cognitive impairment in independent practice along with the myriad other issues we see in routine care."

• Burnout and dissatisfaction: Some respondents expressed discouragement and frustration, noting the emotional toll and financial pressures, especially in independent practice.
• Feeling unsupported: The combination of poor compensation, high demands, and lack of systemic support leads to disillusionment with care of cognitively impaired patients.