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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: Read the rest of this entry »

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