About a month ago we told you about this featured report on National Public Radio concerning screening for dementia. Why, the report asked, is testing for cognitive impairment not being administered to everyone age 65 and older? We thought about the NPR report a few days ago when we discovered this related story on the NextAvenue website, and we decided it was time for a follow-up, since the topic of cognitive screening is a hot one these days.
Cognitive Assessment: are the Tests Reliable?
The gist of the NextAvenue article is that, yes, the Alzheimer’s Association (and many other geriatric care professionals) recommend screening everyone 65 and older for early signs of dementia. But some physicians – and many seniors – worry that the tests can be inconclusive and unreliable, creating emotional strain and serving no useful purpose. With the number of Alzheimer’s cases expected to triple in the coming 30 years, this is clearly going to be a point of contention for seniors and their families.
According to author Edie Grossfield writing in NextAvenue, a big part of the recommendation from the Alzheimer’s Association centers on the role of the family physician in early screening and detection of cognitive impairment. In its 2019 Alzheimer’s Disease Facts and Figures report, “The association says all people 65 and older should receive some kind of assessment of their thinking and memory functions and that the primary care setting is the best place to do it. It should be a part of routine exams.” This assessment, the association says, can take place during routine physical exams or as part of the Medicare Annual Wellness Visit which we wrote about here on the AgingOptions blog just last week.
Cognitive Assessment: Barely 1 in 6 Screened Annually
Those assessments are definitely not taking place now, according to the Alzheimer’s Association survey. Their statistics show that only about half of health care consumers who are 65 and older have ever received a cognitive assessment, and just 16 percent are screened annually. “Experts say early detection of mild cognitive impairment, which can lead to dementia and Alzheimer’s disease, is important in terms of treatment and other factors,” says the NextAvenue article. To back up their recommendation for universal screening, the Alzheimer’s Association website lists these advantages stemming from early detection:
- Once early signs of dementia are detected, doctors can prescribe treatments that can reduce common symptoms, such as memory loss and confusion, for a limited time
- Early detection creates opportunities for patients to take part in clinical trials
- Screening may help doctors treat other health issues, such as controlling blood pressure, quitting smoking, and regular exercise, which can improve cognitive function
- Early detection of cognitive problems helps patients get the emotional and social support they need, as soon as possible
- Screening helps patients and families plan more effectively for the future, including making financial and arranging for care services.
Cognitive Assessment: What is the Emotional and Practical Impact?
But in spite of those reasons in favor of universal testing, there are those who see problems with assessing every senior, especially seniors with no signs of impairment and who are not complaining about thinking and memory problems. The main concern, says NextAvenue’s Grossfield, is disagreement over the accuracy of the tests doctors most commonly use to detect cognitive problems. (The article contains links to three of the most frequently-employed assessment tests so you can see for yourself.) One expert on cognitive impairment, geriatrician Dr. Terry Quinn, has investigated the accuracy of several brief cognitive assessment tools, and she expresses some major reservations about universal testing, especially for those without symptoms. “Not only [is there a] lack of evidence to show the tests are accurate, but there’s [also a] lack of information about the emotional and practical impacts they can have on people when the tests miss problems or falsely find problems,” she states.
As Dr. Quinn told NextAvenue, “We don’t know whether asymptomatic older adults want screening, we don’t know the effects of an erroneous label of cognitive impairment, we don’t know if screening tests predict future cognitive change, we don’t know the health economics of screening, we don’t even know what to do with a positive screening result. There are many examples of screening tests that do more harm than good.” She and others advocate more research before cognitive screening is rolled out on a universal scale.
One of the simplest tests, called the Mini-Cog, takes only three minutes to administer. But when it was evaluated for accuracy, one report found that the test failed to detect almost a quarter of those with dementia, and it incorrectly identified 27 percent of test subjects as having some cognitive decline when in fact they were healthy. And consumers themselves are skeptical. “About one-third believe the tests are unreliable,” NextAvenue reports, “and 24 percent agreed that ‘the idea of all seniors being tested for thinking or memory problems is insulting.’” Roughly one-fifth of seniors surveyed said that, since there’s no cure or treatment for thinking or memory problems, there’s little point in testing for them.
Cognitive Assessment: Part of Comprehensive Planning and Preparation
Whether you or a loved one are facing dementia or simply trying to plan for your health care needs as you age, we hope you’ll call us here at AgingOptions and allow us to refer you to a geriatric physician – a geriatrician – in your area. This is the health care professional you need to see, a doctor who understands the particular physical, emotional, and cognitive issues of aging patients. As for the rest of your retirement planning, we can help you there as well by showing you how all the facets of your retirement plan fit together like pieces of a puzzle. Along with your medical needs – helping you preserve your health – you need to take your housing desires into account, to make certain you’re living in the environment that’s right for you. In retirement, your finances will play a pivotal role, as will your legal affairs. Finally, unless your family is aware and supportive of your retirement plans, you could be heading for major family conflict in the future. An AgingOptions LifePlan is the one plan we know of that blends all these elements together: financial, legal, medical, housing and family.
If you’re ready to learn more, why not take a few hours and attend one of our free LifePlanning Seminars? There’s no obligation whatsoever – just bring your questions and prepare to have your eyes opened about a new approach to retirement security. For all the details, visit our Live Events page, or call us during the week and we’ll gladly assist you. We hope to see you very soon at an AgingOptions LifePlanning Seminar.
(originally reported at www.nextavenue.org)