To Screen, or Not to Screen
Tuesday, December 4, 2007
You walk into the room, but you can't remember why. You've forgotten where you left your keys. Lapses like that seem to be happening more often. The beginnings of Alzheimer's disease? Maybe, maybe not.
What's the best way to find out? Most experts say you should raise concerns with your physician. But an Alzheimer's organization and an ad hoc panel that met last month say that anyone older than 65 -- and anyone who has a family history of the disease -- should request and receive memory tests on a regular basis.
The Alzheimer's Foundation of America, a nonprofit advocacy group, endorses memory tests for all older Americans. And the Alzheimer's Disease Screening Discussion Group -- sponsored by Pfizer and Esai, the makers of the Alzheimer's drug Aricept -- recently urged screening for all those 65 or older or residing in an assisted-living or long-term-care facility.
But some experts worry that mass screening could do more harm than good by giving false reassurances to some and causing others needless worry.
One in seven Americans over age 71, about 3.4 million, have dementia. The majority, 2.4 million, have Alzheimer's disease, according to a recently published study funded by the National Institute on Aging.
As people age, the odds of dementia rise. Of those 71 to 79, only 5 percent have the condition; for those 80 to 89, the figure rises to 24 percent; and for age 90 and older, it's 30 percent, according to the NIA study.
Early screening, said Alzheimer's Foundation chief executive Eric Hall, can help catch the disease when it's still possible for drug therapy to help; it can also give family members more time to plan for caregiving, financial and other needs. Finally, a test might show that the memory loss is due to some other, more treatable medical condition.
For the past five years, the foundation has sponsored a National Memory Screening Day each November, when free screening is offered at 2,000 sites across the country. Participants are given a series of questions and tasks that take about five minutes to complete. If the results hint at any problems, they are told to follow up with their physician.
Edna Hayden, 83, said she's glad she took the memory screen at her assisted-living facility in Fort Worth. She did so because she had been a bit forgetful, and because she had already learned, from a timely mammogram, that a screening can be a lifesaver.
She's telling friends to get their memory tested. Either way, the testing can lead to action, Hayden said. "If they have [dementia], they can get help. If they don't, they can have the relief of mind," she said. (Hayden passed her test.)
But the Alzheimer's Association, another nonprofit advocacy group, does not support widespread screening, favoring one-on-one consultations with doctors instead.
William Thies, vice president of medical and scientific relations for the association, said there have been no studies proving the value of memory screening for the general public.
And there are downsides, he said. If someone is told his test is normal when it isn't, he has been falsely reassured. If test-takers are wrongly told their results indicate a serious problem, they can have unnecessary anxiety. And if results that suggest a problem don't prompt someone to talk with a physician, the purpose of the screening is defeated, Thies said.
Both the Alzheimer's Foundation of America and the Alzheimer's Association accept drug industry support.
Dallas internist and geriatrician Lynne Kirk, immediate past president of the American College of Physicians, said she performs tests only "when somebody has complaints or concerns about memory or cognitive function."
For otherwise-healthy people, she doesn't see the point. A normal result wouldn't change her advice to patients to maintain brain and heart health by eating a balanced diet, exercising and keeping the mind active. And an abnormal result wouldn't change that advice, either, and might only make someone worry, she said.
The Alzheimer's Foundation would also prefer that people talk with their physicians if they're worried about Alzheimer's. But Hall said many people are afraid to raise concerns about memory loss because they are terrified of learning that they might have a progressive, incurable disease.
The foundation surveyed 1,900 of the 21,000 people it screened in 2006. About three-quarters said they had entered the screening thinking they might have a memory problem, but fewer than 10 percent of that group had ever discussed this concern with their physician. A fifth had not discussed it with anyone.
Thies said that the science currently doesn't support widespread memory testing, just as it didn't support cholesterol screening that some were pushing for in the 1970s, when the therapies then available for reducing high cholesterol had side effects that kept many people from taking them. When statin drugs emerged in the 1980s, the field moved forward, he said.
It took about 15 years for the debate to play out, Thies said. The controversy over Alzheimer's screening is just getting started. ¿
Alicia Ault is a frequent contributor to the Health section. Comments:firstname.lastname@example.org.