Screening for Alzheimer's at Yearly Check Ups: What Do You Think?
How would you feel if your doctor wanted to screen you for Alzheimer’s disease or other dementias as part of your yearly check up? Some experts on Alzheimer’s disease and other dementias are suggesting that primary care doctors perform this service as part of annual check ups, and members of two Alzheimer’s organizations intend to issue joint recommendations on this matter.
Dementia screening could join blood pressure and cholesterol checks
At the recent Alzforum in New York City, sponsored by the Alzheimer’s Foundation of America and the Alzheimer’s Drug Discovery Foundation, experts gathered to discuss how to increase the detection of dementia among an aging population. This concern coincides with the new portion of the Patient Protection and Affordable Care Act of 2010 which calls for Medicare to start in 2011 to pay for an annual wellness visit that includes detection of cognitive impairment, which includes dementia and Alzheimer’s disease.
Not everyone agrees such screening is a good idea. One argument against it is that there are no effective treatments to prevent or cure dementia and Alzheimer’s disease. Professionals who met at the recent meeting, however, argued that there is evidence showing that knowing if an individual has dementia can help doctors provide better overall medical care.
In fact, there is research indicating that people with dementia who received dementia-specific care end up receiving better quality overall medical care than patients not receiving such care. What has not been studied, however, is whether people with normal cognitive function who are screened for impairment fare better than individuals who are not screened.
Other arguments for screening include allaying fears of dementia if a test result is negative, or discovering other conditions that are treatable that may be having a negative effect on memory and cognition, such as depression, diabetes, and hypothyroidism. There is also the argument that knowledge is power: knowing dementia is down the road can allow patients and families plan for their future.
Would you be willing to undergo a routine cognitive function test as part of your annual check up? Would you want to know if you are developing dementia? You can refuse such a test if your doctor suggests it.
Another question is whether screening tests for dementia are reliable. Participants at the Alzforum tended to agree that some of the offerings were effective. Soo Borson, MD, of the University of Washington, noted that “One of the highlights of the meeting for me was the recognition that we have good screening tools and some work well in the primary care setting.”
But which tests should be used to screen for dementia? The Centers for Medicare & Medicaid Services has asked the National Institute on Aging (NIA) to determine which test should be used during an annual wellness visit to screen for dementia. So far the NIA has identified 12 tests that are free of cost and take less than 5 minutes to administer.
However, beyond cost and time to give the test, there are other hurdles to overcome for dementia screening, including lack of time for primary physicians to give the test, lack of resources to do the follow-up evaluation when a patient tests positive, finding dementia care for patients, and the low reimbursement rates for doctors.
Participants at the Alzforum noted that a large proportion of people who have positive results on dementia screening do not return to their doctors for further follow-up. Malaz Boustani, Indiana University School of Medicine, provided an example.
When Boustani offered cognitive screening to 825 adults who were in the Indianapolis Dementia Screening and Diagnosis study, 97 percent said they would undergo screening. However, half of those who screened positive did not return for follow-up. He noted, “We were really surprised about that.” Other studies have yielded similar results.
Older adults may be faced with Alzheimer’s screening as part of their yearly check up by their primary care physician. Such testing faces hurdles and likely resistance from both patients and physicians. If you were offered screening for Alzheimer’s disease, would you accept? What do you think?
Alzheimer Research Forum
Boustani MA et al. Aging and Mental Health 2011 Jan; 15(1): 13-22
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