What kind of screening for Alzheimer’s?

  • The United States is moving toward widespread early screening for Alzheimer’s disease
  • According to one study, that could lead to diagnostic errors
  • What about Belgium?

Should there be widespread early screening for Alzheimer’s, as is done for breast and prostate cancers? The United States and England are moving in that direction. That could be a mistake, according to Australian and English researchers in an article published in the British Medical Journal.

 

According to the researchers, widespread screening of the elderly for cognitive problems is dangerous because it could lead to diagnostic errors in up to 23% of cases. They emphasize that slight cognitive difficulties do not necessarily lead to dementia. Every year, 5-15% of patients with slight cognitive impairment will develop dementia while 40-70% will not, and they may even see an improvement in cognitive function. For the researchers, tests currently in use are not robust enough to differentiate between these situations.

 

According to Jean-Christophe Bier, director of the memory clinic at Erasmus Hospital in Brussels, “to conduct a generalized study is to risk diagnosing someone who might not be aware of it. For some it may cause anxiety. For me there are advantages. It would allow me to talk with the patients and develop a plan of care so that they can continue to be in control of their life as long as possible. To say that, since some erroneous diagnoses are made, further testing should be stopped doesn’t seem to be an adequate response. However, it’s true that we have to find a happy medium between systematic screening and no screening. We also have to avoid using inadequate tools with people who have not noticed any problems. At any rate in Belgium we don’t have the problem of overuse.”

 

What matters most to professor Bier is informing the patient, “We have to explain that it is possible to investigate further when there are memory problems. Tests often allow us to reassure people who are not afflicted by the disease.”

 

Currently, the diagnosis is made based on clinical observation. “There are biological factors that indicate whether someone has a high probability of developing Alzheimer’s disease. Those diagnoses can be made via scans or lumbar punctures. However, like the article’s authors, I think we should not use these tools across the board on everyone older than 60. In any case not until we have a treatment to change the outcome,” he continued.

 

“Comforting to know”

Professor Adrian Ivanoiu, director of the memory clinic at St. Luke University Clinics in Brussels, also thinks that “generalized screening such as is done for breast cancer” should not be done. “But that doesn’t mean that we shouldn’t pay attention. If a patient complains to his or her physician about memory problems, the doctor should take it seriously and send the patient to a specialist just in case. The researchers are right to say that everyone with slight cognitive difficulties will not necessarily develop dementia, but that doesn’t mean that we shouldn’t take these people into account. We have to remember that some people and their families are very distressed when they don’t know what the problem is. Even when the diagnosis is terrible, some take comfort in knowing. That also lets us take steps to make sure the person eats well, takes their medications and does not get taken advantage of by malicious people.”

 

VIOLAINE JADOUL

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