Physician practices are seeing more patients who have concerns over their memory health. Since older age groups are among the fastest growing sub-groups in the world, over the coming decades doctors will continue to see an increasing number of patients with memory concerns.
In order to establish if their patient’s memory problems are just a part of normal aging, or if they are symptomatic of more severe underlying issues, such as Alzheimer’s, many physician organizations are turning to specialty neurocognitive testing companies like Screen Inc. for help.
Adequate test batteries examine the patient’s cognitive ability over several domains: such as memory, fluency and mental control executive functions. By analyzing the test results both relative to sub-populations with similar education and longitudinally, tests are capable of recognizing cognitive impairments very early in patients. The best tests also recommend directions for diagnostic evaluations by placing the results in context. For example, the CANS-MCI evaluates cognitive test results in the contexts of reported head injuries, solvent exposure, exercise, and progressive scales for depression, medications, and alcohol use. In 2011 Medicare began mandating a preventive wellness exam that includes cognitive testing for the detection of impending dementia and Alzheimer’s disease.
Effective cognitive testing is able to differentiate between those memory problems that are consistent with the person’s age and education, and those that are more serious. Our tests are ideal for internists, family, geriatric and neurology practices, community health clinics, hospitals, HMOs and life care centers (assisted living).
In the pre-diagnostic phase, neuropsychological tests help physicians detect important cognitive changes. This detection allows referral to specialists or follow-up with additional testing (imaging, full neuropsychological evaluation, or brain wave study for diagnostic accuracy).
For patients who have already been diagnosed by their physician, continued testing helps physicians judge the rate of cognitive ability changes and the effectiveness of treatment interventions.
Patients Ask: "Should I get a cognitive tests, imaging, or another Procedure?"
There are several reasons that cognitive testing is preferable to any of the other detection procedures:
Basic neuropsychological testing is more likely to provide decision-making information. The amount of change in cognitive ability can be precisely measured by periodic testing. It is at the first point of actual decline, beyond that expected with normal aging, that more invasive tests will be useful.
A major study in the Archives of Neurology concluded that “an elderly person with a significant amyloid burden can remain cognitively normal”. In other words, a PET imaging test that costs thousands may tell you whether or not you have a PROPENSITY to develop Alzheimer’s but not whether or not you are actually starting to develop a disease.
Computerized neuropsychological testing does not involve intimidating or invasive procedures that deter elderly patients from being evaluated. Imagine the reactions to saying, "We would like to take a tap of your spinal fluid to see if you are likely to develop Alzheimer’s."
There are at least six good reasons to offer routine cognitive testing for senior patients:
Many seniors who begin to have memory lapses worry unnecessarily about Alzheimer’s. Regular cognitive testing would help alleviate those worries. In most cases, testing will show that the patient has normal cognitive functioning (for age and education).
In some cases, testing will show that the patient’s memory and executive functions are poor, not due to neurological damage, but because of emotional interference. More extensive evaluation and effective treatment can then be prescribed.
If early testing indicates MCI, and it is diagnosed by follow-up testing, the first stages of Alzheimer's might be slowed. Drugs can be given at its earliest stages. In addition, the earlier other treatment programs are initiated, such as treatment for depression, heart health medications, increased social activity and proper nutrition, the more effective they are in slowing the progression of Alzheimer’s. Thus, early detection through annual testing is critical.
Medical researchers have found that the likelihood of stroke is predictably higher for people who have cognitive declines. Therefore, detecting declining cognitive patterns through annual testing allows physicians to be medically proactive with respect to circulatory health. Medication errors are seriously exacerbated by cognitive symptoms.
For those patients who have been identified as having cognitive declines that is becoming progressively more serious, physicians and caregivers can implement early safety programs and policies for driving, cooking, and finances. There may be dementia prevention activities that are of critical importance to implement as early as possible.
Early detection of active progression toward Alzheimer’s is a gift of time to patients who otherwise would have missed the chances to discuss medical options, to be part of family planning for their future, and to do the things they’ve always wanted to do with friends and family.
For these reasons, many recommend that people over the age of 50 should be screened for cognitive impairments once a year. Annual memory screening is even going to be a mandatory part of the Medicare Welcome office visit and part of annual wellness visits.
We are often asked variations of this question: “Once someone is identified as having cognitive impairments, how can they prevent progression to dementia and the resulting dependency and constricted life that will occur?”
Many habits and actions lower the risk of chronic diseases and boost overall health and well-being. It goes without saying that smoking hurts. It may be less clear but equally important to get treated for depression because that treatment can have a positive effect upon cognitive abilities. The following, in the order of the importance we think is currently established by research, have been found associated with a reduced risk of Alzheimer’s disease:
Regular exercise. In our opinion, this is the habit with the most consistent effect upon the likelihood of further cognitive decline. It’s effect may be mediated by the improvement in brain circulation, along with changes in stress hormone levels. Whatever the mechanisms, there are clear associations between the risk of Alzheimer’s and having better control over type 2 diabetes, lower blood pressure levels, and lower cholesterol levels. If cognitive decline has already been detected, very extensive exercise may be necessary to have a decline-preventing effect.
Intellectually stimulating activities and social activities. We are often asked which mental exercises work the best to counteract decline. The answer from our perspective is that you want to cause a “fire” in your brain. For example, learning to juggle is tremendously stimulating to many parts of the brain. Learning to juggle while you ride a unicycle would be hugely activating. Learning a new language or a musical instrument would also be very activating. Purchasing a set of brain exercises may be useful just because the program would organize your activity, like having a personal trainer might do for your physical exercise. In both, the issue is how much time you do it, not the specifics of what you do. In fact, the issue of what you do may be more important with respect to physical exercise because you have to be very careful in your physical exercise to avoid physical injury. Learning to juggle may be dangerous to your light fixtures, but it is not important that you succeed or that you do some precisely correct mental exercise.
An active social life. Making this happen as an active task is particularly important as you get older because your usual contacts (and your usual activities that can substitute for beneficial contacts) often become less frequent.
Healthy weight and good nutrition. Keep your weight healthy. For many, that means shifting to fruits and vegetables.
Mindfulness training or psychotherapy. A rigorous study* found that women who scored highest on the neuroticism scale—which measures the tendency to feel easily stressed, anxious, jealous, guilty, and depressed—were twice as likely to develop Alzheimer’s disease compared to those who scored lowest. Apparently, these psychological stressors release stress hormones in the body and can affect structures in the brain that are connected to Alzheimer’s disease. Out of the 800 women that researchers followed for almost four decades, 104 of them developed Alzheimer’s. While being either withdrawn or outgoing did not appear to raise Alzheimer’s risk alone, women who were both easily distressed and withdrawn had the highest risk of developing the disease. high neuroticism/low extraversion showed the highest risk of AD dementia. There are many ways to reduce how easily distressed or withdrawn a person is. Some of them are also ways to increase social contact, e.g. yoga or meditation classes.
Staying in the loop. If you have been diagnosed with cognitive impairment, it is important that you seek out the best treatments to prevent further decline. You also can seek out the best ways to avoid progressive decline.
CONCLUSION: Specialty Memory Testing Is Rapidly Increasing
In response to greater demand from senior patients, and encouraged by the Medicare mandate and by allowance of physician fees for memory testing and patient follow-up, physician practices are increasingly turning to specialty memory testing companies like Screen to test their patients’ cognitive health.
Screen hopes you will choose us as a partner in this effort, but even if you choose one of our competitors, the fact that testing is being advanced is very good news for our elderly.