In her commentary, Susan Peschin criticizes the U.S. Preventive Services Task Force for not finding evidence of benefit for screening for dementia as based on sound science ("Alzheimer's again gets short shrift," April 14). On what else should such a profound public health policy be made? It is interesting she mentions breast cancer, the disease over which we have been fighting the most bitter screening war. For although it makes intuitive sense to screen and catch diseases early, for all our good intentions, the more we learn, the more we are finding that screening has been way oversold in breast cancer and a number of other diseases. We are learning the lessons that screening is not without risks: people end up going through pain and anxiety, additional medical tests and complications. They may be administered drugs they don't need. They miss work. They commit suicide. The first "patient" of Jack Kevorkian was a woman diagnosed with Alzheimer's disease.
As others have pointed out, anyone screened for cognitive impairment should be informed of all risks and benefits and should give their full informed consent.
Screening is expensive. It also now implies use of not only memory testing in the clinic but brain scans for amyloid for which three drugs are now approved from three different pharmaceutical companies. Money spent on such screening and testing takes away from funds that are sorely needed to care for patients with Alzheimer's disease.
Dr. Susan Molchan, Bethesda
The writer is a geriatric psychiatrist and former program director for Alzheimer's Disease Biomarker and Diagnostics at the National Institute on Aging.-
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