Dispelling the Fear of Alzheimer’s Testing: Standardizing Cognitive Testing

According to the Alzheimer’s Society, more than half (56%) of people are putting off seeking a dementia diagnosis for up to a year or more, and 62% think that a diagnosis of Alzheimer’s disease or other forms of dementia may mean that “life is over.” According to the Alzheimer’s Association, only half of seniors are being assessed for thinking and memory issues and far fewer are being assessed repeatedly.

Routine cognitive testing is paramount to early Alzheimer’s detection, but many doctors aren’t testing for cognitive disease early. With new drugs and therapies emerging on the market, early diagnosis of cognitive disease is critical. The earlier the diagnosis, the earlier the potential for treatment. Typically, an earlier diagnosis provides a higher likelihood of treatment success. Below, we will discuss:

• The fear of Alzheimer’s testing.
• The standardization of cognitive testing.
• Dispelling the black-box fear of Alzheimer’s testing.

The Fear of Alzheimer’s Testing: Early Diagnoses 

Much of the fear of Alzheimer’s testing stems from deeply entrenched beliefs society has developed surrounding Alzheimer’s disease and dementia. Many individuals worry that being diagnosed with Alzheimer’s will mean a lower quality of life. They may also fear the impact a diagnosis might have on relationships with friends and family, or they may dread the financial impact associated with treatment and monitoring. As a result, individuals tend to avoid seeking medical attention when memory and thinking issues arise, thus delaying their potential diagnosis and ability to intervene.

Early detection of neurocognitive diseases, such as Alzheimer’s, is highly beneficial. When individuals wait to get tested and miss the opportunity for early detection, they deny themselves the benefits of early diagnoses, such as:

• The ability and time to make plans for the future.
• More time to assess and implement potential treatments in the early stages of Alzheimer’s.
• The opportunity to implement lifestyle changes, such as increasing physical activity, controlling blood pressure, eating a healthier diet, and increasing social and mental activity.
• The chance to participate in clinical trials.

The Standardization of Cognitive Testing

While yearly cognitive assessments for seniors are a required aspect of the Medicare Annual Wellness Visit, in a survey, only one in three seniors reported that they were aware of this requirement. Implementing cognitive testing into annual wellness exams is as simple as allotting 10-15 minutes for a pencil and paper legacy assessment or digitized assessment. 

Examples of cognitive assessments that can be implemented into annual wellness visits include:

• The Mini-Mental State Exam (MMSE): The MMSE is a five- to 10-minute assessment scored on a 30-point scale. Patients are instructed to state the current date, count backward, and identify everyday objects.
• The Montreal Cognitive Assessment (MoCA): The MoCA, similar to the MMSE, is a 10- to 15-minute assessment scored on a 30-point scale. Aspects of the MMSE are incorporated in addition to a Clock Drawing Test (CDT) and a two-part Trail Making Test.
• The Mini-Cog: The Mini-Cog takes only three minutes to complete and consists of three steps: 1) the patient is asked to remember three words, 2) the patient completes the CDT, and 3) the patient must then recall and state the three words provided before the CDT.

While such tests cannot determine specific causes or types of cognitive impairment, they can be used as screening tools to determine if elements of cognitive impairment are present to then decide if further testing is needed. These tests may also take a lot of time because of analog measurements, office waiting times, and the need for a real-time analysis.

Dispelling the Black-Box Fear of Alzheimer’s Testing

Much of the black-box fear of Alzheimer’s testing relates to the fear of unknowns. While current cognitive tests, such as those listed above, can help individuals understand the state of their brain, they may leave patients with more questions than answers.

Cognitive assessment technology that provides more specific, comprehensive, and personalized data could help dispel the fears of not understanding one’s brain and/or diagnosis. Deeper, more granular data on cognitive function across many neurocognitive domains can provide the insight and understanding that patients need to feel confident about the state of their brains and their treatment paths.