Thursday, December 11, 2008

How Soon Is Too Soon to Screen People for Alzheimer's Disease?


I wrote earlier about a simple three minute test that might detect Alzheimer's at a very early stage. The test, called the MC-Faq, is simple to administer and can even be done by a family member or friend.
The new screening instrument, referred to as the MC-FAQ, allowed the researchers to correctly classify the 204 participating elderly individuals as cognitively normal, demented, or mildly cognitively impaired with a high degree of accuracy (83 percent). Approximately 30 percent of participants had MCI and 32 percent were very mildly demented.
Personal experience with older people leads me to believe this is a wonderful development. In spite of the accuracy of the test it seems it is highly controversial

It seems that some believe that "knowing" could lead to depression.
"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."
Say what? Can Bill Thies really believe not knowing under any circumstance is better than knowing?

Well Bill let me give you a good example of the effects of not knowing. Its called car crash.

We have a friend I'll call her Joan. One day while I was at the store I saw her standing outside and she seemed disoriented. I walked up and asked her what was wrong. She was very agitated and told me she was lost and couldn't find the hospital. The hospital is a left turn out of her development, a right turn at the corner, and a 1.5 mile drive up the street. I found her about 1.5 miles in a completely different direction. While I am not a doctor, I didn't need the Mini-Cog to tell me something was wrong. While I was trying to sort out the situation she said to me, "I'd be better off dead". I tried to alert her children who lived 1200 miles away  to the problem. They wouldn't listen. Her personal physician never diagnosed her. Two automobile accidents and a year later she was finally diagnosed. She is not doing well.

I understand this is a sample of one. I could write about additional examples here and I will in the future.

It is well known that personal care doctors are not doing a good job of diagnosing Alzheimer's and dementia. We need to put another arrow in the quiver of doctors, this arrow is called the MC-Faq. We need to start educating the baby boomer generation about the test. The current estimate calls for ten million baby boomers to suffer from Alzheimer's.

Put me down in favor of this test.

My name is Bob DeMarco. I am living Alzheimer's from the Front Row. Don't delay. If you suspect Alzheimer's or dementia get the person tested or administer the Mini-Cog on your own. At the end of the day you'll be glad you took action. Don't stick your head in the sand.

The following article frames this issue.
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How Soon Is Too Soon to Screen People for Alzheimer's Disease?

By SHIRLEY S. WANG

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 nonprofit 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.

Email: healthjournal@wsj.com.

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