Does memory screening help spot dementia, or harm?
Indeed, more than 5 million Americans and 26 million people worldwide have Alzheimer’s. Cases are projected to skyrocket in the next two decades as the population ages. Yet few are diagnosed in the earliest stages of the relentless brain decay, when today’s medications are most helpful.
The new report calls on Congress to set a national strategy for dementia detection, and on Medicare to make memory screening part of more new-patient checkups. Meanwhile, it backs community memory screenings, in particular targeting people who already have memory concerns but don’t know how to seek help.
How well do they work? The guideline-setting U.S. Preventive Services Task Force in 2003 decided there wasn’t enough evidence to recommend for or against routine screening. The task force is revisiting that question, and other Alzheimer’s specialists have urged caution.
Making a check of brain function as routine as blood-pressure measurement is a laudable goal, says Dr. Zaven Khachaturian of the Lou Ruvo Brain Institute in Nevada. But correctly diagnosing people with the earliest symptoms is tremendously difficult, hindering that quest, he says.
Among the knowledge gaps: Nearly a million older Americans each year are estimated to develop what’s called “mild cognitive impairment,” or MCI. But no one knows how many will worsen to full-blown Alzheimer’s, or how to predict who will. To fill such gaps, the government is midway through a giant study to see if brain scans help diagnosis; a Mayo Clinic study of MCI’s evolution is tracking 3,000 people in Olmstead County, Minn.; and Khachaturian is planning a similar study to track thousands more Nevada baby boomers.
Plus there’s a key distinction: Would memory screening target just people worried about existing problems, or those at risk of future memory loss because of older age, family history or other factors?
Dr. Ronald Petersen of the Mayo Clinic _ who advises the Alzheimer’s Association, a different national patient-advocacy group _ calls wider screening premature.
No matter the cautions, people may assume they’re “on the road to Alzheimer’s disease,” he worries. “If you’re in a mall and you go into a booth and you take this little five-minute exercise … you don’t know what people are going to do with that kind of information.”
For the truly at-risk, Khachaturian recommends regular monitoring of total cognitive function, not just short-term memory, to spot deterioration from one year to the next.
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