The Benefits of Annual Screening for Cognitive Health

Routine health screenings are now common for a variety of conditions like hypertension, diabetes, and glaucoma. Many health insurance plans, including Medicare, provide no cost or low cost health screenings to their members. The main intent behind these preventive health screenings, or wellness screenings, is to provide an early warning system for both consumers and doctors on potential health issues that require a closer look, saving lives and health care dollars in the process.

So when is the last time you had your memory screened, or had a brain health checkup in your doctor’s office? Probably never. That’s beginning to change, however. Download article PDF.

The idea of cognitive health screening is being driven by the fact that Alzheimer’s Disease and other forms of dementia are a growing problem in the US and globally, costing over $180 Billion in the United States in 2011 — and that big number is before most of the 70+ Million baby boomers in the US have turned age 65, when rates of Alzheimer’s and other dementia begin to rise sharply.

Raising Awareness with Memory Wellness Screenings

One organization that is taking the lead in promoting cognitive health is the Alzheimer’s Foundation of America (AFA), through its memory screening initiative and other public awareness and advocacy efforts. Eric J. Hall, AFA’s President & CEO, spearheaded the creation of National Memory Screening Day, an annual event (this year on November 15 , 2011) designed to highlight the important health and social benefits of memory screening for older adults.

According to Hall, the National Memory Screening Day also provides a great opportunity to educate consumers, caregivers, and health care professionals on the value of cognitive health screening. The AFA’s public outreach with the memory screening day points out that taking a memory screening test can also be a reassuring event for a person and their family, showing that a person’s memory is normal.

Also, in January 2011 Medicare announced a new preventive screening benefit called the Annual Wellness Visit. This free service (for patients) is best thought of as an annual consultation with your primary care doctor on the development, status and update of a personalized health screening schedule, including the notion of “detection of any cognitive impairment”. Here’s an example of a recommended health screening schedule for the Medicare Annual Wellness Visit.

AFA’s Hall says including detection of any cognitive impairment in the Medicare wellness visit is an important first step at the federal level with recognizing the need for broad based cognitive health screening. AFA is urging federal officials to build on this step by including a formal cognitive screening as part of the annual wellness visit.

Adding a formal cognitive health screening to the wellness visit will help promote early detection of memory impairment, which can be the first signs of Alzheimer’s and other types of dementia.

Your Personal Brain Health Screening Profile

One of the best ways to distinguish between the performance of a normal, healthy older brain and one that might be showing early signs of cognitive impairment (a potential flag for Alzheimer’s or other types of dementia), is through annual cognitive health screening tests. This type of screening test takes about 20 minutes and will test cognitive abilities such as short term memory, attention, executive function, and processing speed.

There are a growing number of computerized and paper-based cognitive health screening tools available that can fit the bill for a quick, routine cognitive screening test. The method of how cognitive health screenings are implemented is more important than the “best” cognitive test battery, which will continue to change as new screening tools are developed.

To illustrate why the method of implementing cognitive screenings is important, take a look at these examples:

Cognitive Screening Example – Single Test

Patient A and Patient B (both age 65) take the same cognitive health screening test. A normal score for this screening test is between 90 and 110 points:

Both patients have normal range scores, so things are okay, right? Not necessarily with a single test.  

Cognitive Screening Example: Baseline Test + Annual Tests

Now assume that Patient A and Patient B actually took their first test at age 60 (their baseline test), and then were re-tested annually, producing a total of six test scores:

Notice the large drop in Patient A’s test scores in years 4 thru 6. This drop would likely be a significant “flag” for Patient A’s doctor, resulting in more detailed diagnostic tests (blood test, MRI, cerebrospinal fluid test and other biomarker tests) to determine the cause of this sharp drop in Patient A’s cognitive screening test scores.

However, the only way Patient A’s doctor would know about a potential cognitive health problem is by being able to review the historical trend in Patient A’s cognitive screening results, seeing the sharp drop in recent screening scores.

Viewing the historical trend on a patient’s cognitive screening test results (called a longitudinal health record) is far more useful and insightful for physicians versus a single test score. 

Individual, Family, National Benefits of Cognitive Health Screening

The early diagnosis & treatment of memory and cognitive health problems can yield many positive benefits. Expanding on the cognitive screening example, it could be that Patient A’s worrisome memory decline is due to a simple Vitamin B12 deficiency, which can cause a range of cognitive, motor reflex, and movement disorders.

Dr J. Wesson Ashford, a nationally recognized expert on memory screening at the Stanford/VA Alzheimer’s Center, says that screening for a memory problem can also validate concerns by a caregiver or family member that a perceived memory problem is indeed real. (Dr. Ashford also chairs the Memory Screening Advisory Board at the AFA.)

Dr. Ashford views a positive memory screening result (the test result indicates there might be memory impairment) as a useful first step, rather than an actual diagnosis of memory problems: “Memory screening does not diagnose memory problems. Just as with other screening studies, like breast mammography, only a small minority of positive tests turn out to be due to serious problems,” Dr. Ashford says. In other words, memory screening is meant to cast a wide net to catch potential cognitive impairment, but only a minority of positive tests will turn out to have serious implications.

For the minority of positive memory screening results that are confirmed by diagnostic tests for dementia, Alzheimer’s, and other serious cognitive impairment, early diagnosis can help with:

Patient Safety and Quality of Life: The ability to avoid harmful and potentially tragic events like driving accidents, kitchen fires, and serious financial mistakes are good reasons for cognitive health screenings. Early diagnosis also allows for advance planning while the patient is legally competent – implementing long term care options, establishing a will, proxy, power of attorney, advance directives, etc.

Effective Use of Medication: Drugs such as donepezil have been shown to improve cognitive functioning and also delay dementia symptoms by several months. Most studies indicate that starting medication early in the disease stage is far more effective than waiting until symptoms worsen. In addition, newer medications currently in clinical trials have the (not yet proven) promise of delaying Alzheimer’s symptoms by a number of years, rather than months. It isn’t known when or which of these experimental drugs might be available, but already knowing a patient’s cognitive health status will save valuable time when these future drugs do become available.

Medicare Savings = Taxpayer Savings: A recent study of Medicare beneficiaries aged 65+ showed that patients with Alzheimer’s Disease (AD) or other dementias consumed around twice the amount of health care services versus non-demented patients ($23K for AD/dementia patients vs. $11K for non-demented patients: 2010). Impaired ability for self-care, resulting in a greater number of ER visits and hospitalizations is one of the root causes for the higher cost of care for AD/dementia patients.

Multiplied by millions of patients, the savings to Medicare (and US taxpayers) would amount to many tens of billions every year, through the use of routine cognitive health screening.  

Training and Education for Health Care Professionals

As we move into 2012 one of the priorities for cognitive health screening is training, education and support for the many thousands of health care professionals who will be responsible for implementing and administering what will eventually be millions of cognitive health screenings every year.
A national umbrella organization for Alzheimer’s research and prevention, Leaders Engaged on Alzheimer’s Disease (LEAD), is advocating for increased attention and funding for dementia related training and education for health care professionals. One of LEAD’s recommendations is the creation of “Memory Disorder Centers” around the country, which would serve as test centers for new patient care and management ideas for Alzheimer’s and dementia care.

Public Awareness Campaigns for Cognitive Health

The National Alzheimer’s Project Act (NAPA) created a public-private Advisory Council to help guide federal efforts to coordinate Alzheimer’s research, services, and public outreach efforts.
In a report that AFA submitted last month to the Advisory Council, Hall emphasizes that early detection of memory problems must be part of any strategic plan to defeat Alzheimer’s disease—and that “we have no time to waste in taking action.”

AFA’s recommendations include calling for federal support of public awareness campaigns about the signs and symptoms of cognitive problems; and encouraging routine screening, diagnosis and treatment of cognitive health issues. AFA also notes that clinical trial recruitment for research efforts should include ethnic minorities, in order to more accurately reflect the demographics of people living with Alzheimer’s and other dementia.

Also, to help with proper detection and ongoing quality care, AFA is recommending that the Center for Medicare and Medicaid Services (CMS) consider a requirement that all healthcare professionals who treat persons with Alzheimer’s disease have certification and training in geriatrics and/or dementia. “Both the public and clinicians are not talking about cognitive health as much as they should be. Only by starting the conversation and then taking necessary next steps with treatment and support can we get this epidemic under control,” Hall says.

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