Uncertainty Surrounds Testing for Alzheimer's

Early diagnosis is helpful, but no sure-fire test exists, experts say

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HealthDay Reporter

FRIDAY, Oct. 2, 2009 (HealthDay News) -- The earlier a diagnosis of Alzheimer's disease is made, the earlier treatment can begin. On that, experts agree.

With a growing array of tests available to predict your odds of developing the degenerative brain disorder -- including some sold over the Internet -- it seems easier than ever to figure it out: Do you or don't you have out-of-the-ordinary memory problems? Should you or shouldn't you be worried about late-life dementia?

But answering those questions is not as simple as it might seem. For starters, before deciding whether to take an Alzheimer's test, experts say it's important to consider the pros and cons.

There is no quick or definitive test for Alzheimer's, said Dr. Raj Shah, medical director of the Rush Memory Clinic at Rush University Medical Center in Chicago. The disease now affects more than 5 million Americans, according to the Alzheimer's Association.

One test commonly used by experts such as Shah is called the mini-mental state examination, a test of cognitive function -- including memory, reasoning, communicating and understanding -- to see if deficits exist. Also, British researchers have compared a new test they developed, called TYM, for "Test Your Memory," with other currently available tests. Their report, published in BMJ in early June, found TYM more accurate than many tests. Numerous tests are sold over the Internet.

None of the tests are diagnostic, experts caution, and serve only as a screening, sometimes with results suggesting that the person taking the test needs further evaluation and sometimes not. No test should be a substitute for a thorough exam by a skilled doctor, warns the Alzheimer's Association.

"There's been this search for the holy grail, the perfect test for Alzheimer's," Shah said. So far at least, none has been found.

However, even given the limitations of the tests, the results might allay anxieties.

"The number one fear for older adults is memory loss," Shah said. "A lot of people live in fear that they are going to develop it, so when they start to see some changes in their memory, they become anxious," even though the changes could be within the realm of normal.

So if someone takes the test and passes with flying colors, "it can give the person peace of mind," Shah said. But there's a downside, he pointed out: Depending on the test, it might not be accurate and could be providing a false sense of security.

That's especially true if you're a person of above-average intelligence, said Dr. Gary Kennedy, director of geriatric psychiatry at Montefiore Medical Center in New York City. "If you are highly educated and had an intellectually challenging job, you may be too smart for the screen," he said. "You may have lost a degree of cognitive performance typical of Alzheimer's yet still perform well above the norm on the test," he explained.

"The screens have their limits," he said. Though highly intelligent people might get a false negative, test-takers who are below normal intelligence could get results that say they could have dementia when they're actually functioning within the same norms as they did earlier in life.

And if the results are inaccurate, Shah said, that can waste time and money. "You have to go through the anxiety of further testing and the extra cost, and being concerned that you have Alzheimer's when you don't," he said.

Everyone who has an abnormal screening test result should discuss the results with their physician, Shah said. If the screening test results show substantial memory problems -- and the finding is backed up through a physician's evaluation -- the advantage is earlier treatment.

Another important advantage of knowing about Alzheimer's in the early stages, Shah said, is that people and their loved ones can begin planning for the future -- discussing what medical care or living arrangements might be needed, as well as making decisions about health-care power of attorney and more.

More information

The Alzheimer's Association has information on the warning signs of Alzheimer's.

SOURCES: Gary J. Kennedy, M.D., director, geriatric psychiatry, Montefiore Medical Center, New York City; Raj Shah, M.D., medical director, Rush Memory Clinic, Rush University Medical Center, Chicago; Alzheimer's Association, Chicago; June 9, 2009, BMJ, online

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