Summary: Yes, the results of a new retrospective analysis of nationwide survey data show that cognitive disability in adults is increasing in the U.S. The analysis examines self-reported cognitive disability among people with no clinical diagnosis associated with cognitive disability, with difference identified among adult age groups.
Key Points:
- Cognitive disability is frequently associated with older age, chronic illness, diseases such as Alzheimer’s, and some mental health disorders.
- Between 2013 and 2023, self-reported cognitive disability increased for all adults age 18+.
- Cognitive disability is associated with decreased performance, achievement, and function across life domains, including work, school, and relationships.
Disability and Cognitive Disability Among Adults
Studies show that in 2022, over 70 million people over age 18 in the U.S. reported living with a disability, an increase over the 61 million people over age 18 in the U.S. who reported living with a disability in 2022.
That’s a significant increase, which a group of researchers explored in the new study “Rising Cognitive Disability as a Public Health Concern Among US Adults: Trends From the Behavioral Risk Factor Surveillance System, 2013–2023.” The research team describes their study as follows:
“This study analyzes national trends in self-reported cognitive disability from 2013 to 2023 using BRFSS data, with a focus on differences across age groups, racial and ethnic populations, and key social determinants of health.”
Here’s the definition of cognitive disability used by the Behavioral Risk Factor Surveillance System (BRFSS), an annual, large-scale survey – the largest telephone survey in the world – that collects and analyzes data about health-related risk behaviors, chronic health conditions, and other health related factors among U.S. adults:
“Cognitive disability refers to serious difficulty concentrating, remembering, or making decisions because of a physical, mental, or emotional condition.”
This study took a novel approach to identifying cognitive disability by narrowing the focus of the research, and examining only self-reported cognitive disability among people with no diagnosis of depression or other conditions that can affect cognitive performance. The research team analyzed 4,507,061 responses to two questions.
Researchers phrased the first question, designed to identify people with cognitive disability, as follows:
“Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating, remembering, or making decisions?”
They phrased the second question, designed to isolate cognitive disability not related to depression, as follows:
“Have you ever been told by a doctor, nurse, or other health professional that you have a depressive disorder, including depression, major depression, dysthymia, or minor depression?”
Researchers included patients who answered “yes” to the first question and “no” to the second question. To attain data appropriate for population-level conclusions, the study sample of roughly 4 million was weighted to represent between 190 million and 200 million adults in the U.S., depending on the year. Statisticians followed weighting guidelines established by the BRFSS “to ensure that the data are representative of the US adult population.”
Let’s take a look at what they found.
Cognitive Disability in Younger Adults: Increasing or Decreasing?
Researchers left out data from 2020 for various reasons, including decreased data collection due to the pandemic, and to better isolate data on what they classify as “nonpsychiatric cognitive impairment.”
First, we’ll share the big picture, ten-year trend data.
Cognitive Disability in All Adult Age Groups: 2013-2022
- 2013: 5.3%
2014: 5.2% / 2015: 4.9% / 2016: 5.5% / 2017: 5.6% / 2018: 6.0% / 2019: 6.2% / 2020: n/a 2021: 6.7% / 2022: 7.1%
- 2023: 7.4%
This information offers a quick answer to the question we pose in the title, and confirms that cognitive disability in adults is increasing in the U.S., with a significant 40% increase between 2013 and 2023 for all adult age categories.
Cognitive Disability by Detailed Age Group, 2013 and 2023
- 2013:
- 18-39: 5.1%
- 40-54: 4.5%
- 55-69: 5.1%
- 70+: 7.3%
- 2023:
- 18-39: 9.7%
- 40-54: 6.0%
- 55-69: 6.0%
- 70+: 6.6%
In this data set, we see important data. Firsts, a 90% increase for ages 18-39. Second, a 33% increase for ages 40-54. Third, a 17% increase for ages 55-69. And finally, a decrease of 9.5% decrease for people over age 70.
That’s the opposite of what we expected, which was that trends in self-reported cognitive decline would increase with older age, rather than decrease. However, that’s not what the data show. Here’s how the research team describe these results:
“The prevalence of cognitive disability among younger adults aged 18–39 years nearly doubled, increasing from 5.1% to 9.7% making this age group the primary driver of the overall rise in cognitive disability in the United States.”
We’ll discuss these results – and the consequences of this analysis – in the section below.
Cognitive Disability Increase Among Younger Adults: Relevance, Contributing Factors
Self-reported cognitive disability is not a clinical diagnosis related to any physical, mental, or behavioral disorder. However, increases in self-reported cognitive disability in young adults may have serious implications for various aspects of our society and culture writ large, including but not limited to:
- Long-term academic achievement
- Consistent workforce participation
- Deficits in early health, healthcare, and education
- Increased stress on health care infrastructure
With those observations noted, the research team offers potential explanations for the increase in cognitive disability among younger adults compared to older adults, for whom increases in cognitive disability are expected.
Possible explanations include:
- Increase in society-wide awareness of the importance of mental health, and by extension, cognitive health.
- Decrease in stigma around talking about mental health and cognitive health, leading to an increase in willingness to self-report cognitive disability.
- Increases in cognitive burden among young adults, associated with increases in social, cultural, and economic stress.
- Stability in cognitive disability among older age groups may indicate improvements in management and care of cognitive decline associated with older age and conditions such as Alzheimer’s disease.
Here’s another salient observation from the research team:
“Self-reported cognitive disability captures the lived experience of functional impairment in this domain and highlights potential unmet needs in the population, making it a valuable metric for public health monitoring and policy intervention.”
That’s a powerful insight. There may be factors associated with cognitive decline in younger adults that we’re missing and need to allocate resources – and our attention – toward identifying and resolving. We can help young adult patients who experience cognitive disability. Recognizing the size and scope of this trend – and its potential negative consequences – is the first step toward offering support for a demographic with previously under-identified cognitive deficits and needs.
Gianna Melendez
Jodie Dahl, CpHT