Cognitive screenings and Alzheimer’s Disease

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.”