Mild cognitive impairment (MCI) has been on the rise as a "diagnosis" in the medical records being reviewed on senior market insurance applications and settlements. On the life side, this is causing increased challenges in getting policies approved by underwriting, and hence increased frustrations at the broker level. Brokers by and large are under the impression that these are merely typical, age related changes and underwriters have the belief that this is early stage dementia-They are both correct! On the settlement side, this is often the cause of unwarranted aggressive life expectancy estimations, a problem for the investor. Here are some insights to help both sides successfully navigate through this impairment.
According to the AGS (American Geriatrics Society); MCI is the intermediate stage between cognitive changes of normal aging and dementia. Although MCI typically shows up years prior to a formal diagnosis of dementia, and there is some increased risk of MCI progressing to dementia, it is not a definitive measure for development of dementia. Approximately 12% of those over the age of 70 that have MCI are3-4 times more likely to develop AD (Alzheimer's Disease).
Mayo clinic developed a general criteria utilized for the identification of MCI: 1) Self reported memory complaints, 2) Objective memory impairment, 3) Preserved general cognitive function, 4) Intact activities of daily living (ADL), 5) Not meeting criteria for dementia.
In the thousands of senior medical records reviews I have completed over the years, it is important to really evaluate the symptoms and patient presentation when the AP (attending physician) has indicated MCI. I have found a number of instances when all criteria have not been met yet the AP indicates this as a diagnosis-always troublesome for the underwriter to make the appropriate assessment yet retain case documentation that will not haunt them on future underwriting audits!
It is clear, based upon the research to date, that MCI is a risk factor for dementia, much the same as hyperlipidemia is a risk factor for coronary artery disease. As such, it would be reasonable to expect a mild rating, but declinations of insurance based upon this single factor would be unwarranted.
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Contact our Expert/Blogger:
Traci Davis, President/Chief Underwriter
tdavis@advanceduwsolutions.com
www.linkedin.com/in/tddavisaus
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Senior assessments require experienced medical underwriters that understand the differences in impairment mortality on applicants and insureds over the age of 65. AUS has that underwriting expertise-contact us today to find our more about our suite of underwriting services!
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