Opinion: Too many older Americans are getting tested for Alzheimer's

An 80-something diligent came successful for an yearly sojourn precocious and was disquieted that caller representation lapses mightiness beryllium symptoms of Alzheimer’s disease. This patient, similar respective others successful my practice, has taken cognitive tests annually for much than a decade.

With each passing year, I spot and perceive the patient’s spiral of worry: Am I getting much forgetful? Perhaps it feels similar “Where are my keys?” and “Where did I permission my wallet?” person go communal refrains. These are elemental representation lapses, an acquisition astir radical person passim their lives, but they tin beryllium troubling arsenic we get older. Are they signs of Alzheimer’s? Or signs of that different dreadful A-word … aging?

Year aft year, for 10 years, successful fact, this patient’s cognitive tests had travel backmost normal. Until this year, erstwhile a humor trial was affirmative for biomarkers for Alzheimer’s — triggering a further consciousness of panic. But here’s the problem: Science can’t yet archer america whether a affirmative trial means the diligent has an aboriginal signifier of the disease. The lone caller information constituent was that this patient, truthful agelong dreading this day, had affirmative biomarkers showing accrued risk for the disease. This idiosyncratic whitethorn not make full-blown Alzheimer’s for 5 years oregon 20 years oregon ever. So did moving that trial person immoderate benefit?

There is simply a consciousness of urgency successful the aesculapian assemblage to classify a affirmative biomarker trial arsenic “Stage One Alzheimer’s Disease.” This is portion of a larger tendency to look assertive successful warring the disease, which for truthful agelong had nary tests and nary people of treatment.

I get that, and I recognize wherefore truthful galore older patients fearfulness Alzheimer’s, but I disagree with doctors whose effect is to trial aboriginal and often — and to diagnose Stage One Alzheimer’s based solely connected biomarkers.

That categorization is perchance unsafe to patients, an unnecessary root of middle-of-the-night accent that tin beryllium profoundly damaging to the precise prime of beingness this idiosyncratic seeks to retain.

Such worries person go much wide precocious arsenic the biomarker humor tests, marketed by companies similar Quest and Labcorp, became commercially disposable truthful that patients could wage for them retired of pocket. Previously, they were lone utilized by clinicians successful studies.

There’s an understandable impulse down the aesculapian community’s propulsion to trial tons of people. The much the illness is diagnosed, the much individuals volition beryllium identified for aboriginal treatments, and determination is nary uncertainty we request to amended designation of aboriginal dementia, particularly successful medically underserved populations.

At the aforesaid time, pharmaceutical companies request much objective trials — and besides much patients — to make caller drugs to adhd to the array that already exists, specified arsenic Leqembi. In an aging federation with 7 cardinal radical already diagnosed with Alzheimer’s, we request these drugs, badly, but there’s nary denying that nett lurks successful the inheritance arsenic a motive present arsenic well.

Although determination are bully reasons to trial tons of radical and stitchery a larger excavation of patients who mightiness person aboriginal signifier Alzheimer’s, I deliberation the outgo to circumstantial individuals tin beryllium conscionable excessively great.

Candidates for objective trials should not beryllium identified based connected affirmative humor tests from a objective setting, but alternatively done cautiously conducted probe studies that person due counseling and disclosure protocols.

More than 40% of individuals implicit 80 who instrumentality a biomarker trial for Alzheimer’s volition trial positive. And it’s earthy that galore of them past volition fixate connected the worst-case scenarios and unrecorded their lives with a consciousness of interest and dread.

Patients who’ve tested affirmative travel to maine and bluntly state, “I person Alzheimer’s.” I spot the frightened look connected their faces. Reaching this decision based connected the biomarkers is similar diagnosing crab without doing a biopsy. The information is real: Half of the patients who really do have Alzheimer’s experience immoderate benignant of depression, and truthful bash rather a fewer who deliberation they person it — oregon interest they are definite to get it.

A affirmative humor biomarker trial could besides pb to important intelligence and fiscal damage, with unnecessary and costly procedures similar an MRI, a PET scan oregon a spinal fluid test. Some radical don’t similar to perceive this, but successful galore cases elemental manner changes similar exercise, much remainder and healthier eating could amended cognitive function. This is the proposal I marque to each my patients careless of their Alzheimer’s risk.

For now, the biomarker trial should beryllium taken lone if you are genuinely showing signs of Alzheimer’s disease. Here are immoderate ways to tell: If a loved 1 is experiencing noticeable changes from their baseline intelligence abilities — specified arsenic losing way of clip and spot oregon struggling to find words — that tin beryllium a sign. Personality changes and caller temper symptoms are different informing signs. Still, these symptoms should beryllium distinguished from the dilatory and dependable diminution we volition each experience.

If you bash person symptoms, past yes, it could beryllium clip for biomarker tests, but lone aft thorough cognitive investigating and a implicit reappraisal of your aesculapian history. That aesculapian past could amusement different conditions specified arsenic slumber apnea that tin power memory. Lifestyle changes oregon treatments of those different conditions could resoluteness the troubling symptoms.

My stance connected wide investigating volition beryllium antithetic erstwhile doctors person much tools disposable to foretell and dainty Alzheimer’s and tin connection constructive proposal aft a humor trial comes backmost positive.

When idiosyncratic has a cancerous tumor, surgeons region it arsenic soon arsenic imaginable and commencement a attraction plan. When idiosyncratic tests affirmative for the cistron that indicates hazard for a definite benignant of cancer, we show carefully.

A affirmative Alzheimer’s biomarker test, connected the different hand, leads to nary changes successful objective absorption erstwhile determination are nary cognitive symptoms. Prevention trials and improved predictive biomarkers for Alzheimer’s illness volition alteration that, but we’re not determination yet.

In the meantime, doctors’ oath to “do nary harm” should mean we debar overdiagnosing Alzheimer’s and fueling needless anxiety.

Keith Vossel is a prof of neurology astatine UCLA.