Early detection can be vital
Early detection of Alzheimer’s disease can be crucial, giving patients a chance to plan for the future and take medication to keep symptoms from worsening, at least for a while. Many geriatric experts advocate routine screening of older people for the disease, to give patients their best shot at treatment.
But a number of patient advocates and physicians say the push for widespread screening is premature. There are no data showing that screening people who have no memory complaints actually leads to better outcomes. And there are potential negative consequences, these critics say, including false positives that needlessly put patients at risk for depression or anxiety.
”The worry,” says Bill Thies, vice president of medical and scientific relations at the Alzheimer’s Association, is that patients may react to positive results in ”inappropriate” ways. ”Will they become fully depressed?” he says. ”If that’s the case, then you’re going to obscure any public-health benefit.”
Screening proponents say the Alzheimer’s tests are quick, easy to use and can identify most people with memory problems who warrant further evaluation. Screening can involve just a few tests, such as word recall. And it could be part of a routine physical for patients over 65 years old, according to a proposal from the Alzheimer’s Disease Screening Discussion Group – a group of academic health centers, drug companies and patient-advocacy groups that met at a drug-industry-sponsored meeting last month.
One organization, the Alzheimer’s Foundation of America, has held a national memory-screening day each of the past five years. ”What we’re trying to do now is make memory screening a part of the actual physical process,” says Eric Hall, chief executive of the foundation. ”What would be so terribly wrong with doctors capturing a baseline memory score for future reference?”
Many researchers, as well as the Alzheimer’s Association, a non-profit focused on disease research and patient care, believe that in patients who aren’t exhibiting noticeable memory problems, the benefits of screening aren’t clear. Some patients worry that if they screen positive, they might lose their driver’s license or job, or have trouble getting life insurance, even if their symptoms don’t yet affect their daily functioning.
Some doctors also note that it doesn’t help to diagnose people who don’t yet have noticeable memory problems because existing medications appear to help only patients who are already suffering clear symptoms.
The lack of systematic follow-up for screening adds to the worry for some doctors and researchers. A recent study in the Journal of General Internal Medicine found that of 524 adults screened in a doctor’s office, only one in five who screened positive was referred to a specialist or received a diagnosis or a prescription for medication.
Study author Soo Borson, professor and dementia specialist at the University of Washington, says researchers didn’t determine why there was so little follow-up, but lack of time may be one issue.
What doctors and geriatric researchers generally agree on is that testing is helpful in diagnosing patients who are already showing signs of memory problems.
Kathy Frank of Beech Grove, Ind., had concerns about her 66-year-old husband, Charles, for nearly two years. She remembers a time when he forgot his Social Security number and other instances when he couldn’t recall certain words. When she suggested he get tested, he jokingly replied, ”I think you should get tested.”
After becoming disoriented at work several months ago, however, Mr. Frank was concerned enough that he went to the doctor, who found he had had a stroke. The doctor recommended further evaluation, in part because Mr. Frank had a family history of Alzheimer’s. He went through a battery of neuropsychological tests that lasted several hours and evaluated many aspects of his cognitive functioning. So far, tests indicate Mr. Frank doesn’t have Alzheimer’s, but his memory will be re-evaluated next year.