August 8, 2022

Should you try at-home screening for memory loss?

Alzheimer's disease and other forms of dementia are thought to affect more than 55 million people around the world. This number is expected to rise to 78 million by 2030 and 139 million by 2050. There are simply insufficient neurologists, psychiatrists, geriatricians, neuropsychologists, and other specialists to diagnose these people with cognitive decline and dementia. Primary care doctors and nurses will need to take charge.

Despite the fact that this may seem like an obvious and straightforward answer, my friends who work as primary care physicians remind me that they hardly have time to handle the essentials, such as managing blood pressure and diabetes, and that they have no time to conduct elaborate cognitive tests. Even a simple test like the Mini-Cog, where they have to draw a clock and remember three words, takes too long for them. So, how will we diagnose the growing number of people with Alzheimer's and other forms of dementia in the next few decades?

A self-administered test can check for memory loss. 

In 2010, doctors at The Ohio State University Wexner Medical Center's division of cognitive neurology developed a cognitive test that people can use on their own to check for memory loss. This idea of a cognitive test that people can give themselves could help primary care providers who are short on time. People can take this test at home, and they can bring the results with them to the office. The results can then be used to decide if more tests are needed or if a specialist should be called in.

The Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), and other clinician-administered tests as well as traditional neuropsychological testing have all been favourably compared to the exam known as the Self-Administered Gerocognitive Examination (SAGE). However, SAGE's accuracy in identifying people who will later develop Alzheimer's disease or another form of dementia, however, was unknown.

Predicting the future

The authors conducted a retrospective chart analysis on 655 patients seen in their memory problems clinic over a follow-up period of up to 8.8 years in order to provide an answer to this topic. They contrasted the MMSE with their SAGE exam.
They classified the clinic's population into four groups based on both the initial and subsequent clinic visits. Let me define a few words before I explain the groups:
When cognitive impairment results in impaired function, it is called dementia
Mild cognitive impairment (MCI) is a condition in which cognitive performance is normal but there is cognitive impairment. 
Subjective cognitive decline happens when people worry about their memory and thinking, even though their thinking and reasoning are fine.

Individuals in the four groups they compared had 
Alzheimer's disease-related dementia.
Subjective cognitive decline.
MCI that coverted to Alzheimer's disease dementia.
MCI coverted to another type of dementia. 

In their ability to forecast how each of these groups would do over time, they discovered an unexpectedly strong connection between the SAGE test and the MMSE. Additionally, they discovered that the SAGE test was able to predict a person with MCI who would acquire dementia six months earlier than the MMSE.

What is required to implement this test in practice today?

Primary care physicians will still need the training to know how to utilise and interpret the results of a self-administered test that patients can complete at home. However, there is no denying the value of such instruction. After the training is over, the knowledge acquired should be able to prevent missed—or incorrect—diagnoses, in addition, to literally hundreds of hours of clinician work.
Another concern is how people would respond when instructed to do a 10-to 15-minute cognitive test at home and return the findings to their physician. Will they carry it out? Or will those who need the test the most refuse to take it or falsify the results? I have a notion that those who are worried will do the test, as well as those who typically heed medical advice. It's possible that some people who would benefit from the test's results won't take it, but many of them wouldn't take the "normal" pencil-and-paper testing with the doctor or clinic staff either.

A novel approach to cognitive testing

Previously, clinician-administered cognitive tests and family/caregiver questionnaires were the two types of screening tools used to assist in assessing whether someone was developing cognitive impairment that could progress to dementia. A self-administered test is the third category of screening tool now available. In the coming decades, there will be a growing number of people with Alzheimer's disease and other types of dementia. Finding them will depend heavily on the use of these self-administered tests.

Do you want to test yourself?

The SAGE test can be downloaded here. Please bring the answer sheet to your doctor, as instructed on the website, so they may grade it and discuss the results with you.



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