A new survey conducted by the Harvard School of Public Health and Alzheimer Europe points to a strong consumer desire for “predictive testing” – the promise of a medical screening test that can gauge the likelihood of a person declining into Alzheimer’s Disease (AD) as they age. Over two thirds of respondents said that they would like to have this kind of cognitive health screening test available.
The interesting question then is: What kinds of Alzheimer’s screening tests are available? The screening tests fall into three main categories:
(1) Cognitive Assessments: Traditionally performed by medical specialists (neuropsychologist, neurologist, etc), these tests measure short term memory (usually the first cognitive skill to fail in early AD), and other important cognitive domains. There are also some newer computerized cognitive screening tools that can be used in the doctor’s office and other general practice & primary care settings like a community health clinic.
A big benefit of computerized cognitive testing is that it can be administered by trained office staff, rather than a scarce resource like a neuropsychologist. The computerized tests also tend to take less time (20 minutes vs. 1 hour or more for a traditional assessment), and are fairly low cost. With the new Medicare Annual Wellness benefit now in place, having an efficient method to screen millions of patients each year will become increasingly important.
(2) Biomarker Tests: There has been a lot of attention and controversy surrounding biomarker tests for Alzheimer’s and dementia. News stories appear weekly on the latest research for a simple blood test, or more exotic choices like testing cerebrospinal fluid for predicting the chances of Alzheimer’s. The National Institute on Aging (NIA) and Alzheimer’s Association currently do not recommend the use of biomarker tests for clinical diagnosis — the right choice at this point, given conflicting research data and lack of standards on biomarker screening for AD.
(3) Genetic Testing: Fairly easy and straightforward to do nowadays, but not very useful for predicting AD, since lifestyle and environment variables play a large role in determining the chances of Alzheimer’s. The one exception: if there is a strong family history of early onset AD (before age 65), also known as Familial Alzheimer’s Disease – FAD, then genetic testing should be considered.
The public survey, which was conducted in the United States, Germany, France, Spain and Poland, provides some very useful insights for both the health care and public policy communities.