Screening for Alzheimer's carries its own risks [Letter]

I write in response to Susan Peschin's recent commentary on Alzheimer's disease ("Alzheimer's again gets the short shrift," April 14).

Ms. Peschin contends that we are not doing enough to screen for Alzheimer's Disease, and she faults the U.S. Preventive Services Task Force, an independent panel charged with developing guidelines for primary care clinicians, for not recommending widespread dementia testing.

As a geriatric physician who has been caring for dementia patients for more than 20 years, I have found several problems with screening.

First, it is not always accurate and can lead to labeling someone with Alzheimer's Disease when they do not in fact have progressive dementia — a diagnosis that can have significant emotional and financial repercussions for patients.

Dementia is a variable disease, Some of my patients progress rapidly in a matter of months, while others are fairly stable after a decade. Labeling them does not impact that reality.

Second, broad testing with scans and labs, visits to neurologists and even trips to specialized dementia centers do not alter the disease's progression.

Only about six in every 1,000 cases of dementia are fully reversible, and most of those are discovered by simple tests performed by a primary care doctor.

Third, there is no treatment for Alzheimer's. The available drugs do not alter the disease's course; they mask symptoms only marginally better than a placebo and only for a brief period of time. They also have side effects.

So once we make a diagnosis of Alzheimer's disease, then what? In my experience, the onset of dementia is something that can be ascertained by a doctor-patient-family consensus without sophisticated screening and without labeling. After that, strategies to confront and cope with the disease can be derived.

Before Medicare or insurers begin to pay for screening they should start helping families and patients cope with the disease by deferring the cost of day care, home care, exercise programs and support groups.

These are the most crucial ingredients needed to enable people to contend with a very frightening and little-understood disease. Simply putting a label on it, however, accomplishes nothing.

Andy Lazris, Columbia

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