Memory-loss tests for elderly hot issue

At age 77, Alice Pickett of Seattle is healthy and active, but every once in a while, she temporarily forgets why she walked into a room or where she put the car keys.

She worried that it might be the start of Alzheimer's. So Pickett decided to face that possibility and asked her doctor for a cognitive exam.

She missed only one question.

"I was pleased with myself. It was a really fun game," said Pickett, who now feels she can get on with her life.

Pickett is part of a debate emerging nationally and in the Puget Sound area over whether older adults should be tested routinely for memory loss, as most are tested now for high blood pressure and cholesterol.

The issue is fueled by widespread concern among health-care professionals, the federal government and others that Alzheimer's could become epidemic if a cure is not found, and a growing belief by some that early detection may be the best hope of halting dementia.

Among the questions being raised: If such tests were routine, at what age should they be given, and where? Only in a doctor's office? Or is a shopping mall OK? Who gets to know the results?

"People have surprisingly strong feelings about this," said Dr. Soo Borson, director of the Memory Disorders Clinic at the University of Washington. "Largely because of the baby-boomer generation and their fears about losing capacity."

The answers aren't clear cut. While early diagnosis can help patients and families prepare, cognitive tests — a series of oral and written questions typically done in a doctor's office — can be affected by age and education as well as interpretation.

Experts advise results be confirmed by a doctor.

Even if test results lead to a diagnosis, doctors often don't follow up with treatment, so a person might be left in limbo.

There also are concerns that early diagnosis could lead to depression, anxiety or stigma, and questions have been raised about the implications for getting a driver's license or long-term-care insurance.

An estimated 5.1 million people in the U.S. — or one in eight age 65 and older — have Alzheimer's. As people live longer, it is thought the numbers will rise — 11 million to 16 million people by 2020.

Most dementia goes undiagnosed early on.

At the national level, a panel of medical experts, funded by the makers of an Alzheimer's drug, is pushing for routine screening for anyone 65 and older and on admission to nursing homes and assisted-living facilities.

Already, the Alzheimer's Foundation of America, a nonprofit advocacy group, promotes National Memory Screening Day at thousands of locations. But another advocacy group, the Alzheimer's Association, doesn't recommend screening adults who report no memory problems. It says evaluation is best in a clinical setting.

In the Puget Sound area, the subject of routine testing for Alzheimer's evokes dramatically different views.

"The whole issue came up when groups promoting drugs for Alzheimer's disease saw this as a huge market. Which it is," said Dr. Eric Larson, executive director of Group Health Center for Health Studies. "It's in their best interests to get as many people screened as possible."

"But there's a fighting chance it could do more harm than good."

The Alzheimer's Society in Bellingham — part of the national Alzheimer's Foundation — is one of the few organizations that provides regular, free memory screenings.

But so far, no local primary-care provider appears to routinely screen older patients for dementia.

At Group Health, "We haven't made a decision. I'd say it's still in evolution," said Dr. Marty Levine, medical director of senior care. "We are watching the science evolve and listening to our patient base. When the science is right, we'll do it."

At Virginia Mason Medical Center, about two dozen internists recently met to discuss the topic. Their consensus: The evidence is not compelling that finding the disease before the patient reports symptoms would be helpful.

"We are watching the national conversation about it," said Dr. Julie Pattison, an internist with Virginia Mason.

Others are less equivocal.

"Yes. There should be universal screening in primary care," said Dr. Elaine Peskind, associate director of the University of Washington's Alzheimer's disease Research Center.

Peskind carries this message wherever she speaks. The tests available are simple and can take very little time. Medications can't cure or reverse the disease but are moderately beneficial in slowing progression and improving function.

Also at the UW, psychiatrist Borson supports universal screening, but only if doctors are ready to follow up with a good care program.

Meanwhile, some individuals don't want to find out whether Alzheimer's is in their future.

Right now Kristie Hammond's 54-year-old brain works well. Still, her mother died from Alzheimer's at age 74, after living with it for years. Forgetting a word can make Hammond wonder: "Is this the start?"

At least for now, she wouldn't seek a test to see what lies ahead — "I've got to be ready to accept the results emotionally. If they were positive, that's a really hard thing to consider."

Marsha King: 206-464-2232 or mking@seattletimes.com