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Why Screen For Alzheimer's?
To treat it early in its
course (the earlier the better): Many of the promising treatments
for Alzheimer's, and just about all the protective or preventive agents,
are hypothesized to have greater symptom-delaying effects if they are
started very early in the disease process. It appears that the cholinesterase
drugs slow down the progression of AD and they might help put off the
need to go into a nursing home.
Beusterien, KM et al Impact of Rivastigmine use on the risk of nursing
home placement in a US sample. CNS Drugs, 18, 1143-1148, 2004.
So that eligible patients
can be offered treatment for treatable dementias and participation in
drug trials. Screening can play a useful role in the detection of
a cerebrovascular disease that looks like AD but isn't. There may be treatment
for the vascular problems that will improve cognitive abilities.
Clarfeld, AM The decreasing prevalence of reversible dementias: an updated
meta-analysis. Archives of Internal Medicine, 163, 2219-2229, 2003.
Because
patients with Alzheimer's are at high risk of economic hardship and inability
to follow health-maintaining routines: Not only does the delay in
diagnosis miss an opportunity for delaying treatment, but, because the
disorder involves memory loss, the delay increases the chances of other
problems. For example, people with AD have trouble following prescribed
treatment for their hypertension, infections, psychiatric problems, or
diabetes unless helped. The increase in cost just for managing these other
medical treatments ("co-morbid" conditions, what a term) is
multiplied with each increase in AD symptoms
Reference:
American Psychiatric Association. Practice guideline for the treatment
of patients with Alzheimer's disease and other dementias of late life.
Am J Psychiatry, 154 (Suppl): 1-39, 1997.
Fillet, H et al Health care utilization and costs of Alzheimer's disease:
the role of co-morbid conditions, disease stage, and pharmacotherapy.
Family Medicine, 34, 528-535, 2002.
So
the person and family can plan for the future (e.g for the fact that AD
patients are at high risk of economic hardship and inability to follow
health-maintaining routines. Somewhere around one half of the mild
and even moderate dementia cases are not suspected by physicians. Widespread
screening would probably double the number of detected MCI and mild AD
cases, allowing for much better risk avoidance.
Boustani, M et al Implementing a screening and diagnosis program for dementia
in primary care. Journal of General Internal Medicine, 20, 572-577, 2005.
So that safety and caregiver
stress issues can be addressed. It takes an average of 30 months from
the time family members notice the initial symptoms of dementia for the
person to be diagnosed with Alzheimer's, according to a study by Linda
Boise, Ph.D., M.P.H., and colleagues at the Oregon Health Sciences University
in Portland. The researchers conducted in-depth interviews with 244 primary
caregivers and other close family members in order to understand why the
diagnostic process takes so long. The single biggest reason, cited by
72 percent of caregivers, was that they knew very little about Alzheimer's
disease, and for a long time simply did not imagine that the person's
changing behavior and deteriorating cognitive abilities were manifestations
of an illness. Half of caregivers said they thought the changes were a
normal part of aging. The presence of dementia is a risk factor for family
violence, and a lot of this might be avoided.
References:
Paveza, GJ et al Severe family violence and Alzheimer's disease: prevalence
and risk factors. Gerontologist, 32, 493-497, 1992.
American J. of Alzheimer's Disease April 19, 1999.
Some of the complications of Alzheimer's can be best managed (or even avoided, in some cases) by early and repeated screening. These are serious, costly, and stressful complications (e.g. incontinence, aggression, psychosis).
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Research at Screen, Inc.* |
*Screen, Inc. offers a reliable longitudinal screen testing for possible Alzheimer's disease via the detection of Mild Cognitive Impairment and, thus, provides the first step toward early detection of Alzheimer's for purposes of early treatment. Alzheimer's Disease testing can improve the quality of life. There is no single diagnostic test for Alzheimer's Disease, and early screening for mild cognitive impairment offers a useful method for finding out who needs a full neuropsychological battery for the professional diagnosis of Alzheimer's. The CANS-MCI is an easily-administered screening battery for detection of mild cognitive impairment that indicates the need for a full, professional neuropsychological or imaging evaluation, at which the presence of Alzheimer's can be evaluated by formal testing.