Early Memory Loss and Underwriting With a growing population of older applicants, underwriters are seeing a greater incidence of early memory loss without clinical evidence of dementia (i.e. applicants not diagnosed with Alzheimer’s Disease). What is this condition? Is it the early or prodromal phase of dementia? As important, what are the underwriting implications? There have been several syndromes proposed to identify patients with the "prodromal stage" of dementia. These are defined as individuals who appear to be in a transitional state between normal aging and dementia. At present there no single definition that is universally accepted. The following is list of names this disorder has been given in the medical literature. Each name has its own clinical criteria which makes the underwriting process even more complicated:
While there may be no agreement about the name of the condition, there is agreement that some form of deterioration of the brain is occurring. But how do you separate the transitional group from normal aging or other medical problems that mimic the condition? There are well known medical conditions that can masquerade as dementia or cognitive impairment. Hypothyroidism This is very common in older adults and can result in slowed intellectual and motor activity.
Depression Depression can occur in up to 1/3rd of individuals with suspected dementia.
Once other medical conditions have been ruled out, the question becomes one of management. Here are some key points to remember:
Common sense safety and management issues include:
Q: How do we know which individual with suspected "prodromal dementia" progress to Alzheimer’s disease? A: We don’t. There is currently no to way say which patient will progress. Even more problematic, we know that not everyone with "prodromal dementia" will progress beyond early memory loss. Some will simply "stay put." Others will progress but at a slower rate and stop short of a major dementia diagnosis. Q: Why don’t we simply put all of these individuals on Aricept or Exelon? A: While it sounds tempting to simply give our current Alzheimer’s medication to these individuals, there is no proof that this approach would even work. These medications are not that effective with Alzheimer’s disease in the first place. If we are going to medicate the "prodromal" group, we would be better off with medications that seem to reduce the incidence of Alzheimer disease (i.e. statins like Lipitor and anti-inflammatory drugs like Motrin). Q: Are these individuals insurable? A: Yes. Since they are not officially diagnosed with dementia and depending on their other medical conditions it is definitely worth shopping on behalf of this insured. Q: How would they be rated and how should their case be presented to carriers? A: They may well be standard risks based on the rest of their medical history and the "functional history." See these prior RiskTutor newsletters: |
