DR. MOHLER: Dementia screening — The case for forgetting to take the tests
MOHLER’S MEDICATION MAXIMS
Free Press Health Columnist
Last week in the grocery store, I experienced an anguishing few minutes. Coming down the frozen food aisle was a lady for whom I had cared for many years. I delivered two of her children. I had helped her husband manage his diabetes for two decades. I COULD NOT REMEMBER HER NAME. I turned my cart 180 degrees and headed into the produce section to think and finally recalled, “Lisa.”
Lose your car in the parking lot? Can’t find your keys? Is this the forgetfulness of a normal, aging brain or is this the beginning of dementia? Should you and I have testing to figure it out?
Screening for Alzheimer’s dementia is tempting. Testing ranges from self-administered recall of lists of words, caregiver-administered mental status exams, CAT scans, MRIs and genetic analyses.
The case against screening is strong.
First, there is no one test that definitely makes the diagnosis, particularly early in the illness. Often, there is uncertainty, anxiety, more testing, more stress.
Second, there is no proven way to prevent the disease or its progression. The Aricept and Namenda-type drugs are only minimally effective in slowing the disease — perhaps a few months at best. They are expensive and fraught with side effects. Even in well-established dementia, I try to discourage patients and their families from using these drugs.
Third, the sad diagnosis of dementia is often associated with depression, hopelessness and family distress. Making this dire diagnosis a few months or years sooner rather than later, simply prolongs the anguish that dementia patients and their families experience.
Dr. Mohler has practiced family medicine in Grand Junction for 38 years. He has a particular interest in pharmaceutical education. Phil works part-time for both Primary Care Partners and Rocky Mountain Health Plans. Email him at firstname.lastname@example.org.
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