Baseline Cognitive Testing: Early Warning System for Alzheimer’s and Mild Cognitive Impairment?

A recent New York Times article reported that a spinal fluid test for amyloid beta (a brain protein) can be very accurate for predicting Alzheimer’s, especially for people who have already reported memory loss problems.

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While a biomarker diagnostic test like this is very promising, there are some challenges and drawbacks to widespread use:

  • The medical term for a spinal tap is lumbar puncture, in other words inserting a needle into your lower spine and drawing out spinal fluid.
  • Most people will think twice about submitting to this kind of invasive procedure if there isn’t a pressing, immediate need, like testing for meningitis.  Also, most primary care doctors may opt to send the patient to a specialist for this procedure, which will increase cost and take more time.

On the other hand, imagine if a person has already taken a cognitive baseline test, including measurements for memory recall.  If a subsequent cognitive re-test shows memory decline greater than what is normal for age-related memory issues, an spinal tap for amyloid levels can be ordered to confirm what the cognitive re-testing results indicate, which might be the beginning of Alzheimer’s or another serious cognitive disorder.

Computer-based cognitive testing is non-invasive, can be standardized to test for specific conditions, and can be repeated to produce an accurate history (known as a longitudinal health record).  We have the research evidence and software tools to implement national standards for cognitive testing, but a lot of work still needs to be done in creating a common lexicon for cognitive tests, how they are implemented, and how a standard reporting format with common metrics could be implemented.