A Test for the Early Detection of Alzheimer’s Disease

Liz Arledge is all too familiar with the ravages of dementia. Her mother died of Alzheimer’s, and one of her brothers has been found to have the progressive brain disease as well.

So when she heard about a self-assessment test from Ohio State University to help detect early signs of dementia, Ms. Arledge, 71, decided to take it. “I was worried,” she said. “I needed to know where I stood.”

The test was developed over five years by a team led by Dr. Douglas W. Scharre, a neurologist at the Ohio State University Wexner Medical Center. Known as the Self-Administered Gerocognitive Examination, or SAGE, the four-page test can be completed in about 10 to 15 minutes by patients at home, or while in the waiting room at the doctor’s office. The test, downloadable free on the medical center’s website, is now used at doctors’ offices nationally.

Ideally, said Dr. Scharre, physicians would screen older patients for possible memory and thinking problems during routine office visits. But often, doctors are busy, and patients don’t ask about it — perhaps because they fear what they will learn. That means many patients do not seek medical advice until their condition is quite advanced, he said. While there is no cure for Alzheimer’s, there are drugs that may help treat its symptoms. And those with an early diagnosis may be eligible for clinical trials that offer access to potentially helpful medications.

Just as important, catching symptoms in the earlier stages can help families plan for the necessary, and often costly, care that lies ahead. The annual cost of caring for someone with Alzheimer’s is roughly $57,000 on average, and families pay 60 percent of the tab, according to a recent report from A Woman’s Nation, a nonprofit media initiative.

Dr. James E. Galvin, a professor of neurology and psychiatry at New York University Langone Medical Center who has used the SAGE test with patients, said with early detection patients can have a say in how their care is structured, and who they want to manage their finances as their condition progresses. “They can have those discussions coherently,” he said.

Early detection also can help avoid potential financial problems that may result from impaired thinking and reasoning skills. One recent study from researchers with the Federal Reserve Board and the University of Michigan, for instance, found that spouses who handled household financial responsibilities often delayed shifting those tasks to a more capable partner, even in the face of cognitive problems. “In particular,” the study found, “this switch often occurs well after the original financial respondent has reported having difficulties handling money.”

Earlier detection may help families intervene before problems become serious, Dr. Scharre said. “Just by knowing that a mother, father or spouse has cognitive issues, you might increase supervision,” he said. That can avoid missed doses of medication, he noted, or help “make sure you don’t do something dumb with your finances.”

Roughly 4.7 million Americans have Alzheimer’s disease, and as many as 22 percent more of those over age 60 have mild cognitive impairment.

The SAGE test is done using paper and pencil, rather than online, to avoid intimidating older users who may be uncomfortable using a computer. It is intended to test different parts of the brain equally; it includes questions on language, reasoning, problem-solving and memory skills. Research found that about 80 percent of people with mild thinking and memory problems will be detected by the test, while 95 percent of people with no problems will have normal SAGE scores.

Dr. Scharre cautions that poor results on the test are not definitive, but suggest that more detailed neurological and psychological testing be conducted. Thyroid problems, stroke and conditions like sleep apnea could also be indicated. “It’s not a diagnosis of Alzheimer’s,” he said. “It’s saying, ‘There’s a concern,’ to help start the conversation.'  ”

You can complete the test and take it with you when you visit your doctor, he said. If the results are normal, they can serve as a baseline, for comparison with results in future years.

Ms. Arledge, who lives in Circleville, Ohio, said she was comfortable with the results of her test, which included a question asking her to name 12 common items found in a kitchen. Although she hasn’t yet reviewed it with her doctor, she discussed her results with relatives who also took the test. “It did put my mind at ease,” she said.

Here are some questions about early dementia screening:

Q. Where can I find the SAGE test?

You can download the test free and print it out at bit.ly/1cWqCIe.

There are four versions of the test, to avoid a practice effect in case people take it multiple times. All are equally valid but you should take just one, said Dr. Scharre. The test is best scored by a doctor, so the site’s scoring instructions are directed toward physicians. A score of 17 or higher, out of a maximum of 22 points, is considered normal; a score of 16 or below generally indicates a need for further evaluation.

■ Are there any concerns about self-screening for dementia?

Dean M. Hartley, director of science initiatives for the Alzheimer’s Association, cautions that dementia screening tests in general are best administered by a health professional. If you do not have your results scored by someone knowledgeable, he noted, you risk misinterpreting the results.

If the results are concerning, a doctor or nurse can put them in perspective and discuss a course of action, helping reduce anxiety. “We do feel it’s important to get an early diagnosis,” he said, “but we feel it should come in a medical setting.”

Dr. Galvin at N.Y.U. notes that there is a risk with any self-screening test that users will try to self-diagnose, or that they will not act on the results. But generally, people using the tests are concerned that they may have a problem and are looking for a way to broach the subject with their doctor, and the test can help them do that. “I see it as a great benefit,” he said of the SAGE test.

■ Where can I find information about financial planning for someone with Alzheimer’s?

The National Institute on Aging offers fact sheets for financial and legal planning on its website at 1.usa.gov/1rcWOgL, and so does the Alzheimer’s Association at bit.ly/19qnFl4.

(Source: nytimes.com)