The Alzheimer’s Foun­da­tion of Amer­ica just released a thought­ful report advo­cat­ing for wide­spread cog­ni­tive screen­ings after the age of 65 (55 given the right conditions).

Accord­ing to the press release,

- “The report shat­ters unsub­stan­ti­ated crit­i­cism and instead empha­sizes the safety and cost-effectiveness of these tools and calls on Con­gress to develop a national demen­tia screen­ing policy.”

- “Lift­ing the bar­ri­ers to early detec­tion is long over­due, Hall said. “Con­ver­sa­tions about brain health are not tak­ing place. We must edu­cate and empower con­sumers to talk openly about mem­ory con­cerns, par­tic­u­larly with pri­mary care providers, so they get the atten­tion and qual­ity of life they deserve.

- “Demand for screen­ings is evi­denced by the suc­cess of AFA’s recent sixth annual National Mem­ory Screen­ing Day held on Novem­ber 18, dur­ing which an esti­mated 50,000 peo­ple were given free con­fi­den­tial mem­ory screen­ings at nearly 2,200 com­mu­nity sites nation­wide. Dur­ing last year’s event, approx­i­mately 16 per­cent of indi­vid­u­als who had a face-to-face screen­ing scored pos­i­tive and were referred to their pri­mary care providers for follow-up. An AFA sur­vey of par­tic­i­pants revealed that fewer than one in four with self-reported mem­ory com­plaints had pre­vi­ously dis­cussed them with their physi­cians despite recent visits.”

Excel­lent report avail­able: here

Please note that the Alzheimer’s Asso­ci­a­tion recently argued in the oppo­site direc­tion (no screen­ings) — which prob­a­bly trig­gered this response.

We see emerg­ing trends that sug­gest the posi­tion in favor of cog­ni­tive assess­ments may in fact gather momen­tum over the next few years: wide­spread com­put­er­ized cog­ni­tive screen­ings in the US Army, insur­ance com­pa­nies like OptumHealth adding such tools to its clin­i­cal decision-making sys­tems, polls such as the Amer­i­can Soci­ety of Aging’s a cou­ple of years ago indi­cat­ing a very strong demand for an “annual men­tal check-up”, the avail­abil­ity of use­ful assess­ment tools and research-based pre­ven­tive advice.

The start­ing point is to under­stand what those assess­ments are NOT: they are not diag­nos­tic tools. When used prop­erly, they can be used as a base­line to track per­for­mance in a vari­ety of cog­ni­tive domains over time, so that both the indi­vid­ual AND the physi­cian are not blinded by a one-time assess­ment, com­par­ing an indi­vid­ual with his or her peers (instead of his or her past per­for­mance) when seri­ous symp­toms have fre­quently already been going on for a while.

Our con­trib­u­tor  Dr. Joshua Sil­ver­man, from Albert Ein­stein Col­lege of Med­i­cine, recently gen­er­ated a nice debate on the topic by ask­ing our read­ers their reac­tion to these 3 questions:

1) Even if my cog­ni­tive abil­i­ties were declin­ing, knowl­edge of this would leave me worse off.

2) I am con­cerned that fam­ily, friends, physi­cians, employ­ers, or insur­ers would treat me dif­fer­ently if they found out I had cog­ni­tive decline.

3) Under­stand­ing my cog­ni­tive strengths and weak­nesses will moti­vate me to estab­lish and adhere to a per­son­al­ized brain fit­ness program.

You can read his whole post, and the thought­ful answers, here: Can We Pick Your Brain regard­ing Cog­ni­tive Assessments?

Joshua wrapped-up the debate by saying:

“Since there is a diver­sity of views, it is dif­fi­cult to sum­ma­rize. How­ever, most respon­ders empha­size that knowl­edge of one’s cog­ni­tive sta­tus is empow­er­ing, regard­less of age, con­di­tion, or whether one’s cog­ni­tion is improv­ing or declining.

I am in total agree­ment with this imper­a­tive to mind the brain, and under­stand­ing the many poten­tial con­cerns that fol­low will allow our soci­ety to man­age this infor­ma­tion responsibly.

An impor­tant caveat is that as Sharp­Brains enthu­si­asts, we are not rep­re­sen­ta­tive of the pre­vail­ing opin­ions in most com­mu­ni­ties. We need bet­ter research to sup­port this claim, but my impres­sion is that many still view cog­ni­tive decline as inevitable and unmod­i­fi­able and would not be pre­pared to use objec­tive feed­back on their men­tal abil­i­ties to empower or motivate.

Thanks to Sharp­Brains and a grow­ing seg­ment of the health­care, pri­vate sec­tor, and gov­ern­ment uni­verses, we are wit­ness­ing cul­ture change and a shift toward pre­ven­ta­tive approaches.

I know I don’t need to tell this com­mu­nity that suc­cess­ful brain aging is achiev­able, but each of us should con­sider how we can trans­mit this mes­sage to those around us.”

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