Better Methods Needed for Community Screening for Alzheimer's Disease

Improved screening tests and community resources for follow-up care would help

August 04, 2003

Public Affairs

Belmont, MA - Although as many as 1.75 million undiagnosed Alzheimer's disease (AD) patients could benefit from a national memory screening program, better methods are needed to make current screenings efficient, report McLean Hospital researchers in the August issue of the Journal of the American Geriatric Society. This finding is based on the results of a regional screening in 10 sites throughout Massachusetts, New Hampshire and Vermont in 1999.

Using a seven-minute test (7MS)TM, a brief cognitive test developed to identify individuals with high probability of AD, the screeners tested 659 individuals. Of those tested, 110 individuals were referred for further evaluation-92 were identified as having high probability of dementia and 18 others showed enough signs of impairment to warrant a second screening in six to nine months.

Ultimately, 10 individuals were known to have been newly diagnosed with AD as a result of the screening and another six were found to have previously unknown medical or psychiatric illness, although data was not available for all participants.

"The screening program was better received by the public than anticipated, but there were factors which may have resulted in the diagnosis of relatively few new cases among those recommended to seek further testing," says lead author Janet Lawrence, MD, of the Memory Clinic at McLean Hospital. "This appeared to result mainly from obstacles faced by cognitively impaired individuals in accessing medical care and uncertainty among primary care physicians as how to respond."

Co-author of the study Donald A. Davidoff, PhD, director of the Neuropsychology Department at McLean Hospital, agrees the lack of adequate follow-up care hindered the value of the screenings.

"The most troubling limitation to the effectiveness of a large-scare screening project derives from the quality of follow-up care," he says. "Of the physicians responding to our survey, more than half indicated that they planned to follow up with patients, but many did not pursue further appropriate testing."

Lawrence notes the failure to provide adequate follow-up care might indicate lack of diagnostic resources in the community. "The availability of these resources would be necessary for the effectiveness of a national screening program," she says.

The researchers explain that the lack of follow-up is not the only deterrent to instituting a screening program. Lawrence and her colleagues concluded that the 7MS, while chosen as the best test at the time, has limitations.

"Before a large-scale program can be implemented, however, we need to develop more efficient and accurate screening tests and to make sure that appropriate follow-up care is available," says Lawrence.

"A national screening program has the potential to identify thousands of people in the early stages of dementia, giving them the benefits of early psychopharmacological and psychosocial interventions. Development of such programs will be essential to take advantage of emerging treatments," she notes. McLean Hospital maintains the largest research program of any private U.S. psychiatric hospital. It is the largest psychiatric teaching facility of Harvard Medical School, an affiliate of Massachusetts General Hospital and a member of Partners HealthCare.

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