Expert panel says 鈥渘o鈥� to widespread testing for Alzheimer鈥檚, dementia

A says that as many as 5 million Americans have Alzheimer鈥檚 disease or some other form of dementia. Every 67 seconds someone in the United States develops Alzheimer鈥檚 disease or dementia. That鈥檚 470,000 Americans this year alone.

Given that these thieves of memory and personality are so common and so feared, should all older Americans be tested for them? In the U.S. Preventive Services Task Force said 鈥渘o.鈥� Why not? Even after conducting a thorough review of the evidence, the panel said that there isn鈥檛 enough solid evidence to recommend screening, especially since not enough is known about the benefits and the harms.

Screening means testing a seemingly healthy person for signs of a hidden disease, like Alzheimer鈥檚 or cancer.

Why is early testing for Alzheimer鈥檚 and dementia not recommended when early testing for something like breast cancer is recommended? In part it has to do with treatment. While there are effective treatments for cancer, such as chemotherapy, radiation, and surgery, so far there aren鈥檛 any truly effective approaches to stop the forward progress of dementia. While some medications can slow the progress of Alzheimer鈥檚 disease, their side effects can be damaging.

鈥淭here are certain diseases in which we know that early detection can lead to early intervention, which can stave off worse outcomes, but if you don鈥檛 have any kind of disease-modifying therapy at hand, it doesn鈥檛 make a whole lot of sense to screen people who don鈥檛 have symptoms,鈥� Dr. Aaron Philip Nelson, assistant professor of psychology at Harvard Medical School and author of The Harvard Medical School Guide to Achieving Optimal Memory told me for an article that appears in the April 2014 Harvard Women鈥檚 Health Watch.

Testing for dementia

Checking people who have no symptoms of dementia using questionnaires, blood tests, or brain scans has long been controversial. One key sticking point is that tests available today can鈥檛 paint an accurate picture of future dementia risk. 鈥淭here鈥檚 no test that can tell you that somebody is definitely going to get Alzheimer鈥檚 disease,鈥� says Dr. Deborah Blacker, professor of psychiatry at Harvard Medical School and director of the Gerontology Research Unit at Massachusetts General Hospital.

There is one gene test, but it鈥檚 for a rare type of Alzheimer鈥檚 disease known as familial early-onset Alzheimer鈥檚 disease. It accounts for less than 5% of total cases, and typically starts before middle age. Even getting a brain scan to look for the clumps of protein known as amyloid plaques that are characteristic of Alzheimer鈥檚 disease can鈥檛 accurately predict a future diagnosis.

When you should be tested

If testing healthy adults every few years isn鈥檛 worthwhile, when does it make sense to test for dementia? When someone shows signs of memory loss, difficulty thinking, or other signs of so-called cognitive impairment, say experts. Individuals and their loved ones need to be alert to changes in memory and function. Doctors should also be aware of differences in their patients鈥� mental abilities. When someone has symptoms, they should get an evaluation, Dr. Blacker says.

Yet memory can naturally start to slip as you get older, and it can sometimes be hard to tell whether lapses are due to normal age-related memory loss or true mental impairment. Here鈥檚 a guide to help tell the difference:

*What鈥檚 normal*	*See your doctor if鈥�*
You forget the name of your high school science teacher	You forget the name of your best friend or grandchild
You make a mistake while balancing your checkbook	You often forget to pay your bills
You get lost when visiting a new doctor	You get disoriented in your own neighborhood
You forget what day it is, but soon remember	You keep forgetting the date and lose track of time
You sometimes have trouble finding the right word	You regularly have trouble finishing sentences, or you often use the wrong names for things
You misplace things like your car keys, but you can retrace your steps to find them	You often lose things and can鈥檛 retrace your steps to find them

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Knowing for sure

If you鈥攐r one of your loved ones鈥攈ave noticed that you鈥檝e been having memory lapses or other signs of cognitive impairment, see your primary care provider. You鈥檒l get a series of tests to check how well your brain and nervous system work. You鈥檒l also be asked questions to gauge your short-term recall, attention, and language skills.

Keep in mind that Alzheimer鈥檚 disease and other forms of dementia aren鈥檛 the only causes of memory loss. Conditions like an underactive thyroid gland (hypothyroidism) or vitamin deficiency can also interfere with mental function. Poor sleep, depression, and stress can affect memory, too.

Improving memory might be as easy as getting more sleep or having a medical condition treated. If you are diagnosed with early-stage memory loss, your doctor can guide you through the next steps, lay out your options, let you know what to expect, and help you and your family plan for the future.