Weighing the Benefits of Early Screening for Alzheimer’s

With the first of 70 Million boomers in the United States turning 65 next year, the topic of memory screening tests for Alzheimer’s and other forms of cognitive impairment is becoming more commonplace. An added push also comes from new Medicare rules for an “Annual Wellness Visit” that (in theory) includes screenings for cognitive impairment.

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The combination of a huge demographic flow into late middle age, and national policy shifts to support screening for memory impairment brings up some interesting questions:

1. How will cognitive screening for 70+ Million people be accomplished? Given the large number of annual screenings, the logical choice is in the physician’s office or other primary point of care. Is the typical doctor’s office prepared to offer a simple cognitive screening test? What type of equipment and skills do they need to make this happen?

2. Is there a common test standard and common reporting standard for cognitive screening? There are literally dozens of computer based and paper based cognitive screening tools in use today, all with different subtests for cognitive domains (episodic memory, executive function, reaction time, etc), and all with different scoring methods. What are the benefits and drawbacks to using a standardized test battery vs. a “pick and choose” approach?

3. Is there agreement in the health care community on what a cognitive screening test result means? If the intent of a screening test is a quick “red light/yellow light/green light” result, are clinicians in agreement on the red light definition for example? What are the ethical considerations in communicating screening test results to patients?

Enabling a national test standard for cognitive screening will obviously take some time to work out, but a consensus on cognitive screening should happen sooner rather than later. Recent data from the Alzheimer’s Association points out that the total Alzheimer’s care burden could reach $1 Trillion annually by 2050, and that a modest five year delayed onset of AD could save Medicare (and US taxpayers) $360 Billion a year by 2050. Routine cognitive screening to catch early signs of Alzheimer’s will be necessary to achieve the goal of delayed AD onset.