Alzheimer's disease and its associated dementia can be a scary prospect for individuals and families faced with it. Between 2.4 million and 4.5 million Americans suffer from this debilitating, incurable disease, according to the National Institutes of Health. That figure is expected to rise as the baby boomers age.

Community memory screening events are becoming increasingly popular as individuals and their families seek to detect dementia in its earliest stages—before it destroys patients' memories and thinking skills. But many physicians warn against these screenings, which are often ineffective when it comes to detecting dementia, and can leave test-takers feeling scared and powerless.

There are thousands of memory screening tests available, some self-administered online, some given in the community by health care professionals—usually in the form of a questionnaire. The Alzheimer's Foundation of America, the advocacy group that funds National Memory Screening Day, promotes screenings overseen by health care professionals only.

"If someone goes online and does a self test, even if there are two pages of explanation of the results, I'm not sure that people understand what they are reading," says Eric Hall, the foundation's president and founder.

Hall says a health care professional can explain what a negative result on a memory test means and educate the individual and family members on what type of questions to ask the doctor. Most importantly, Hall says, a health care professional is there to emphasize that a negative result on a memory test is not an Alzheimer's disease diagnosis but simply means the individual should to go to a doctor for follow-up tests.

On the other hand, the U.S. Preventive Services Task Force (USPSTF), an independent panel of government experts that assesses the effectiveness of clinical services, such as memory screenings, has found insufficient evidence to support routine dementia testing in older adults. According to the USPSTF, screenings are only sometimes effective when it comes to detecting the cognitive impairment associated with dementia. And because treatment for Alzheimer's is limited, the task force found no evidence that the quality of life benefits of catching it early with memory screening outweigh the psychological stress of being labeled with an incurable disease.

"We should not screen for a disease we cannot effectively treat. If we could prevent Alzheimer's disease then it would be very important for us to identify people in the earliest stages," says Charles DeCarli, head of the Alzheimer's Disease Center at the University of California, Davis. DeCarli does not screen for dementia, but says he would if there was a therapy that could cure or effectively manage the disease.

Along with the logic of dementia screening, DeCarli and other physicians question the efficacy of memory screening tests themselves. For every seven people that come to DeCarli's office after failing a memory-screening test, only one is diagnosed with dementia. "There are many reasons to fail a screening test," he says. "The person may be nervous, or they could be on a medication that impairs their memory."

Memory screening tests are not good indicators of dementia because they offer only a snapshot of someone's mental abilities, says John Morris, director of the Alzheimer's Disease Research Center at the Washington University in St. Louis School of Medicine. Dementia is characterized by a change in a person's cognitive abilities over time. "If you go to a community center and take a memory test, it doesn't say whether you would have scored better or the same a year ago. Screening doesn't tell us if people are changing," Morris says.

7 Comments

1. 1. audramray 10:04 PM 6/16/10

   I am an occupational therapist that works with the geriatric population. I think it is very beneficial to have a memory screening and cognitive tests done. In the first and second stages of dementia the person's family may not even notice anything is wrong. It is in these stages that someone is most likely to get in a car and drive off, forgetting where they are and killing themselves and/or others. I think it should be routine to have memory testing done, especially if that person still has a driver's license or has access to a car.

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2. 2. ramanan50 10:07 PM 6/16/10

   Good read.
   While Dementia is indicated in Alzheimer, all Dementia case need not necessarily be indicative of Alzheimer.
   The disease is due to faulty or absence of communication between neurons in the brain because of decay.
   This may be due to age,heredity or hedonistic habits or infection of the brain.
   Psychological tests are not to be relied upon as they are in the evolving stage still and the tests themselves do not always lead to correct prognosis.Details are are available at ramanan50.wordpress.com under Psychological tests.
   Right approach would be to consult the Family physician and relatives.
   Best way to manage would be to provide those afflicted with it, would be to provide them help with understanding.

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3. 3. nanobot mind 01:49 AM 6/17/10

   The assumption that no treatment is available and therefore the testing would be useless is marred by the rigidity of past understanding of Alzheimer's and not the current trends in research. In fact, many studies have shown remarkable effects of factors which reduce OXIDATIVE STRESS in the brain in diminishing the severity of the pathology. Because reactive oxygen species and reactive nitrogen species are higher in the brain than elsewhere in the body, owing to higher oxygen requirements, such buildup specificially targets neurons. Leading to homocysteine buildup, which is very destructive to the vascular system, the "free radicals" also damage DNA, and alter the formation of specific types of lipids. A large degree of their damage is done by the production of prostaglandins and the changes in DNA regulation via prostaglandins and the lipids. This pathology has a genetic and environmental component which is markedly affected by vitamin deficiencies. Multiple lines of research have shown profound improvement of the metabolic systems by supplementation with Fish oil, Vitamin E, Lipoic Acid, Reservatrol (red wine components), Ginko, and CAPE (caffeic acid) found in herbs and citrus. Additionally, Vitamin D, A, B complex are needed for keeping the inflammatory cascade at bay. However, drug companies cannot make money on vitamins and attempt to re-invent these same molecules synthetically with adaptations. For every 50 studies on pharmaceuticals there is only 1 on natural metabolics. Even though these "restoring normal health" substances have good results in research, they aren't "money makers". They don't get attention because they are outnumbered. If people knew this, their nutrition would become a focal point with marked results. Don't give up on a prevention for Alzheimer's just yet. We haven't even scratched the surface. The aluminum in neurofibrillary tangles is from the MMP-9 metalloproteinase, derived from inflammatory signaling I just described. And yes, early detection would be key to starting on a spectrum of anti-oxidant regimen before damage accrues. Whether the low oxygen in the brain is from stroke, and the memory loss is from multi-infarct dementia is irrelevant. The improvement in vascular health and protection of neurons during hypoxia occurs when free-radical scavengers are abundant as in when a person is getting sufficient anti-oxidants in the diet.

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4. 4. Iahmad 05:01 AM 6/17/10

   Very interesting write up. While it is understandable to guess the plight of family members whose loved one is diagnosed with dementia, a combination of life style/ diet change with few medications available may help. It is still better than doing nothing/ not even diagnosing.

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5. 5. bobbydelray 06:26 PM 6/17/10

   Most Alzheimer's caregivers will tell you they wish they had known the signs of Alzheimer's and dementia sooner so that there loved one could have been diagnosed sooner.
   
   The are stories of thousands of persons suffering from undiagnosed dementia getting lose or worst. The situation brings enormous angst and regret to families.
   
   The purpose of screening is to alert the individual and family of possible memory and cognitive problems. It could be mild cognitive impairment, dementia, Alzheimer's, a brain tumor, hypothyroidism, or any of a long list of possible diseases and illness.
   
   Memory testing is a good thing and early diagnosis under any circumstance will likely lead to a better long term outcome.
   
   Bob DeMarco
   Alzheimer's Reading Room
   http://www.alzheimersreadingroom.com

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6. 6. sunnystrobe in reply to nanobot mind 02:46 PM 6/18/10

   To Nanobot Mind: Your letter says it all: Thanks for pointing out the link between dementia and nutritional deficiency! Here in Western Australia, it was found that only nine in a hundred seniors eat what they should, namely, 7 portions of natural plant food per day! No wonder then their brains will be prone to decay. Sudoko is not much help if the right food intake is lacking, and memory tests can only check on the symptoms, just like any other medical tests, such as on diabetes, high blood pressure, & cholesterol. An ounce of prevention is better than a pound of (no) cure! For an easy & medically proven way to a colour-coded, i.e.,plant-pigment based feeding pattern, visit: Youthevity.com

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7. 7. geriatricMD 10:53 PM 6/22/10

   We've successfully used a number of quick Alzheimer screening tests by SpecialtyAutomated at our senior centers and nursing homes for years. These are easy to administer or allow for self testing online. We like that these low-cost tests are available in multiple languages, too, and are just great for driver evaluations. I think they post some brochures and information on their website: http://www.specialtyautomated.com

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