April 24, 2014
Should You Be Tested for Alzheimer’s?

Should You Be Tested for Alzheimer’s?

by John Swartzberg, M.D.  |  

As I’ve gotten older, my memory is certainly not what it used to be. If you also feel you’ve become more forgetful, you may be tempted by the many websites and community groups offering cognitive tests for early signs of Alzheimer’s disease and other kinds of dementia—even if you’re afraid of what you’ll find out. In their simplest form, such tests ask you to remember lists of words or to solve simple problems. There are also advanced medical tests, such as brain imaging scans (notably for amyloid plaques) and genetic analyses, to help predict or diagnose different types of dementia, though these are still largely experimental.

But whatever the type of test, there are good reasons to think twice before undergoing it, unless a trusted health care provider has advised it and has discussed the many potential limitations and risks with you.

Besides questions about the accuracy of the tests, it’s not at all clear that people would benefit if dementia could be diagnosed early. The U.S. Preventive Services Task Force, which evaluates evidence on medical matters for the government, says there’s insufficient evidence to determine whether the tests are accurate and beneficial.

Still, some experts do recommend testing people who are starting to have cognitive problems. Among the arguments made for testing is that an early diagnosis of dementia could allow you and your family to prepare financially, practically and emotionally. Screening can also lead to the diagnosis of types of dementia or other cognitive impairment with treatable causes, such as certain thyroid problems, depression, vitamin B12 deficiency or common medications (including some for insomnia, allergies and depression).

On the con side, a bad test result can lead to worry, depression and family disruption—and in many cases, the “diagnosis” will be a false alarm. There’s no sure way to differentiate between mild cognitive impairment, which may only gradually worsen, and early dementia. And if the results aren’t kept confidential, people might lose their jobs, driver’s licenses or possibly their potential caregivers, and be unable to get medical or life insurance.

Even if a test can determine that you’re at increased risk for eventually developing dementia, what can you do with that information, medically speaking? Unfortunately, there’s no proven way to prevent the disease or stop its progression. Medications for Alzheimer’s are meant only for people who already exhibit clear signs of dementia. Even then, they slow the disease for a few months at best—and they’re expensive. Not surprisingly, some companies that make the drugs advocate wider screening for dementia. The same is true of many makers and marketers of dietary supplements and other questionable (or downright fraudulent) treatments for memory problems.

We urgently need a clearer understanding of dementia (Alzheimer’s in particular), better diagnostic tools and, of course, effective treatments. Even more, we need preventive measures. Further research is necessary before burdening patients and health care providers with screening tests of dubious reliability and unproven benefits.

If you fear that you or a family member may be showing signs of severe memory loss or dementia, consult your health care provider for an evaluation. I’d advise against the self-tests and tests done at community centers and the like, especially if they’re offered by someone trying to sell you some memory-boosting product or program.