Concerns About Dementia Screening

Concerns About Dementia Screening – NYTimes.com.

This article describes a patient who benefited from early diagnosis of a rare form of Alzheimer’s disease. But for most people, early diagnosis of dementia only provides knowledge of a problem for which there is no effective treatment.

the push for ever-earlier dementia screening raises troubling questions for patients and their families. When the diagnosis is early Alzheimer’s disease, the medical profession has little treatment to offer. This month, researchers at an Alzheimer’s Association conference in Boston urged policy makers to think hard before recommending wider dementia screening, saying studies have found no evidence that early detection improves outcomes.

And the experts said that little, if anything, is known about the potential risks of early detection. The diagnosis may cause stress, anxiety, depression and even suicide in patients, and can have implications for employment, purchasing life and long-term care insurance, and one’s overall quality of life, sense of autonomy and self-image.

While there are no easy answers, the article concludes with an encouragement for older adults and their family members who begin noticing signs of cognitive impairment to get a thorough medical examination:

The physician should take a history, do a thorough exam, and rule out a number of potential causes of mental impairment: depression; thyroid, kidney and liver function; vitamin B12 levels; infections; and dehydration and electrolyte disturbances. . . . The physician should also do a careful review of medications, since many drugs can have adverse effects on cognition. . . . Reassuringly, many people who experience mild cognitive impairment do not progress to dementia, and many even return to normal, some studies suggest. A study of primary care patients seen at Wishard Health Services identified 130 patients with mild cognitive impairment. A year later, most were stable, and nearly one-third had reverted to normal.