New Questions to Test Your Parents for Memory Loss and Alzheimer's

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A recent study identifies new questions that you can pose as a test to determine whether your parents are developing memory loss that could indicate the early stages of Alzheimer’s disease. The following is a summary of the study that includes the new test questions toward discovering your parent’s risk of memory loss and progression toward Alzheimer’s disease.

Studies for identifying new questions that can be used to test whether a patient or parent may be experiencing memory loss that can progress to Alzheimer’s disease plays an increasingly important part of early diagnosis and treatment of mental functioning in an aging Baby Boomer generation.

Part of the problem, is that signs and symptoms of slowly progressing cognitive problems often do not attract a physician’s attention until a patient’s mental state has significantly deteriorated. Typically, a physician relies on the input (complaints) of a family member or other informant who has close contact with the parent or patient and can attest to subtle changes in their mental state.

Previously, physicians had to rely on a few relatively simple tests to determine whether a patient was in need of a more-thorough neurophysiological examination to aid in a diagnosis of dementia. Examples of these tests include:

• Clock-drawing test—where a patient is directed to draw the face of a clock on a blank piece of paper, with variations of the test asking the patient to draw in the clock’s arms to denote certain time periods.

• Mini Mental State Examination (MMSE)—where a patient is asked a list of questions in cognition areas of orientation, immediate recall, attention and calculation, delayed recall, and language. One example question from each area respectively, includes asking what is today's date?; asking them to repeat a short sequence of words; asking the patient to begin with 100 and count backwards by increments of 7; asking the patient to recall the three words you previously asked them to remember; and, asking the patient to repeat the phrase “No ifs, ands, or buts.”

Last year, researchers made significant progress in creating a 21-question Alzheimer’s Questionnaire (AQ) test that is informant-based and can be used at home or in a primary care setting to identify parents and patients who may be developing Alzheimer’s disease.

The AQ test is a simple yes/no series of questions in a weighted format that a family member or someone close to the parent or patient can answer in just a few minutes. The simplicity of the AQ test is reflected in an easily calculated total score that is the sum of the number of items that have a “yes” response. A score between 15 and 27(the upper limit) is indicative of Alzheimer’s disease, whereas a score 4 or lower indicates that the person does not have significant memory problems. A score between 5 and 14 indicates that the parent or patient might have amnestic mild cognitive impairment (aMCI).

Amnestic mild cognitive impairment differs from normal age-associated memory loss. Normal age-associated memory loss is commonly referred to a “general forgetfulness.” For example it is normal to forget where your placed your keys, but abnormal if you placed your keys in the refrigerator. It is normal to find it challenging to balance a checkbook, but abnormal if a person is confused by what numbers are and how they are used.

Therefore the value in identifying and knowing that a parent has aMCI means that they could begin treatment earlier rather than later and possibly delay the onset of dementia such as with Alzheimer’s disease.

In fact, new research published in the scientific journal BMC Geriatrics tells us that the same researchers who developed the 21-question AQ test have also determined that select questions from the AQ test can be used to discriminate between normal age-associated memory loss and amnestic mild cognitive impairment.

In the study, the researchers used statistical analysis to interpret data gleaned from 51 cognitively normal (CN) individuals participating in a brain donation program and 47 aMCI individuals seen in a neurology practice at the same institute. Both groups were evaluated via the 21-question AQ test. The goal of the study was to determine which AQ items (test questions) differentiated individuals with aMCI from individuals who were cognitively normal.

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The result of the study showed that 4 of the 21 questions were found to be strong indicators of amnestic mild cognitive impairment (aMCI).

According to lead author Michael Malek-Ahmadi, “People with aMCI were more often reported as repeating questions and statements, having trouble knowing the date or time, having difficulties managing their finances and a decreased sense of direction.”

More specifically per the 21-Question AQ test, the four questions are:

1. Does the patient repeat questions OR statements OR stories in the same day?

2. Does the patient frequently have trouble knowing the day, date, month, year and time? OR does the patient have to use cues like the newspaper or the calendar to know the day and date more than once a day?

3. Excluding physical limitations (e.g. tremor, hemiparesis, etc.), does the patient have trouble paying bills or finances OR are family members taking over finances because of concerns over ability?

4. Does the patient have a decreased sense of direction?

Michael Malek-Ahmadi also states that, “While the AQ cannot be used as a definitive guide to diagnosing AD or aMCI, it is a quick and simple-to-use indicator that may help physicians determine which individuals should be referred for more extensive testing.”

The value of the study’s findings is that these new questions can be used by caregivers and relatives who need a simple test to determine whether a parent or loved one may be experiencing memory loss that could be an early sign indicating progression toward Alzheimer’s disease. By alerting their parent’s physician with question-based observations, a thorough diagnosis can be then initiated followed by prompt and appropriate medical care to delay the onset of mental degeneration.

Image Source:Courtesy of Wikipedia

References:

“Informant-reported cognitive symptoms that predict amnestic mild cognitive Impairment”; BMC Geriatrics 2012, 12:3; Michael Malek-Ahmadi, Kathryn Davis, Christine Belden, Sandra Jacobson and Marwan N Sabbagh

“The Alzheimer’s Questionnaire: A Proof of Concept Study for a New Informant-Based Dementia Assessment”; J Alzheimer’s Dis. 2010; 22(3): 1015–1021; Marwan N Sabbagh, Michael Malek-Ahmadi, Rahul Katari, Christine Belden, Donald J. Connor, Caleb Pearson, Sandra Jacobson, Kathryn Davis, Roy Yaari and Upinder Singh.

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