Cognitive tests a 'first step' to Alzheimer's diagnosis

June 29, 2009 By Judith Graham

The sooner someone is diagnosed with dementia, the better.

Increasingly, that's the mantra of experts in Alzheimer's disease, a condition that robs people of their memories and ability to think.

The Alzheimer's Association is highlighting the message in a new media campaign that began last month on television and is continuing with print ads in local markets.

How does this work? And why deliver a diagnosis of Alzheimer's, an incurable condition that many older people fear, sooner rather than later?

If a family member is becoming confused and forgetful much more often, experts recommend a brief test that can suggest potential dementia. (For 10 possible warning signs of dementia, go to the Alzheimer's Association Web site, alz.org.)

The most common is the Mini Mental State Exam, which asks takers to name several objects, identify the year, date and season, and count backward, among other tasks.

Limitations of the exam include its length and relatively poor ability to identify people with mild cognitive impairment, explained William Thies, chief medical office for the Alzheimer's Association. Mild cognitive impairment is often a precursor to dementia.

A new test by researchers in Britain, called Test Your Memory, may become an alternative. In a recent article in the British Medical Journal, researchers reported the five-minute, self-administered exam detected 93 percent of patients with Alzheimer's.

These brief cognitive tests are "a first step," said Dr. Raj Shah, an Alzheimer's expert at Rush University Medical Center in Chicago. Further evaluation involves ruling out other conditions that can compromise memory, such as stroke or depression, and taking a thorough history with the person and a family member.

Often, more extensive cognitive testing will also be ordered. "It's unrealistic to expect a very brief test to discriminate between normal aging and mild cognitive impairment," said Dr. Ronald Petersen, head of the Mayo Clinic's Alzheimer's Disease Research Center.

What's the value of a diagnosis?

People with mild cognitive impairment or early-stage Alzheimer's can make lifestyle changes -- exercise more, eat diets rich in vegetables and fish, engage in cognitively stimulating activities -- that may improve their quality of life, Shah said.

Also, people who receive diagnoses early can participate in decisions about their treatment and connect with community resources. For instance, those newly diagnosed could put their financial affairs in order or get counseling for depression.

It's important to note that the Food and Drug Administration hasn't approved any medications for use in people with mild cognitive impairment. Researchers have tested drugs commonly used to treat Alzheimer's in these patients, but results are inconclusive, Petersen noted.

With Alzheimer's disease, the medications produce a slight benefit -- a relief of some symptoms for 6 to 12 months for about half of people who take them. No medication has been shown to alter the disease's progression.

For all the emphasis on early detection, many people may not want to know they're at risk for Alzheimer's disease. Indeed, almost two-thirds of people with dementia haven't received a diagnosis, the Alzheimer's Association reports. Currently, 5.3 million Americans are living with Alzheimer's disease.

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