Many experts believe that there is no need for dementia screening for healthy older individuals without cognitive symptoms, a view that was recently supported by a pronouncement from the U.S. Preventive Services Task Force. After evaluating the benefits and harms of various screening and dementia treatment options for individuals with mild cognitive impairment, the task force concluded that there is insufficient evidence to recommend screening for cognitive impairment in older adults.
But what about those of us who are among the “worried well?” Shouldn’t otherwise healthy people who fret about their memory or thinking abilities be tested for AD?
“Individuals should discuss the pros and cons of screening with their physician,” says Janet Sherman, PhD, Chief of Neuropsychology at MGH’s Psychology Assessment Center. “In my work, I find that people who undergo testing often have concerns based on a family history of dementia, or are noticing changes in their cognition and wonder if these changes are due to normal aging or may represent signs of dementia. In general, it is also important for individuals to appreciate that screening does not determine a diagnosis, but instead can determine if further diagnostic testing may be helpful.”
WHAT YOU CAN DO
People with the following cognitive symptoms, especially if they involve a change in functioning, should see a physician or specialist in memory problems for assessment:
- Recent memory loss that affects the ability to work or fulfill responsibilities
- Difficulty performing familiar tasks
- Problems with language
- Disorientation of time and place
- Poor or decreased judgment
- Problems with abstract thinking
- Misplacing things beyond what is “normal” for the individual
- Changes in personality, mood or behavior
- Loss of initiative
Pros and Cons
There are a number of reasons why screening might be beneficial, Dr. Sherman says. In the first place, the testing might reveal that an individual’s cognitive functioning is within normal ranges, in which case the results can help eliminate anxiety.
“Sometimes screening leads to a more thorough evaluation that allows us to reassure people that their memory problems are not due to neurological disease, but are related to aging, or to some reversible condition, such as a vitamin deficiency or depression,” Dr. Sherman says. “Screening can also establish a baseline so that it’s possible to monitor how the indi-vidual is doing over time.”
Even when test results suggest that the individual has early signs of mild cognitive impairment, AD, or another type of dementia, screening can have benefits, Dr. Sherman says. Some of these benefits include:
▶ Patients and their families can make plans for the future.
▶ Patients can be informed of research trials and enrolled in them if they wish.
▶ Because patients are under care, they are likely to hear of new treatments as soon as they become available.
▶ Patients can participate in special programs, such as memory disorders support groups and cognitive rehabilitation therapy.
▶ Patients can benefit from the support and assistance of their physicians and families as their disease progresses, giving them a better quality of life.
▶ Patients can be monitored to determine when changes in their living situation or changes in activities such as driving might be necessary.
▶ Caretakers of patients can learn about and receive supportive services.
Types of tests
Screens for dementia often involve brief cognitive tests taking five to 10 minutes that include tasks designed to evaluate memory, language, and reasoning. If a patient performs poorly on the screen, this would signal a need for further testing, which might include a referral to a neurologist. A neuropsychological evaluation is a more comprehensive cognitive evaluation that takes two to three hours and can help to identify the specific pattern of difficulty and point to possible underlying rea-sons for the difficulties. Other types of testing may include brain imaging, such as MRI or PET scans, laboratory tests that can identify genetic variants linked to early-onset AD, and tests of spinal fluid that reveal the presence of AD biomarkers. As many as 20 percent of individuals who initially screen positive for AD may eventually be found to have normal cognition that shows up on further test-ing.
Individuals who wish to pursue screening for memory or cognitive problems should contact their medical care provider and work closely with him or her to determine what the next step should be.