An 80-something patient came in for an annual visit recently and was worried that recent memory lapses might be symptoms of Alzheimer’s disease.
A Growing Concern
This patient, like several others in my practice, has taken cognitive tests annually for more than a decade.
The Spiral of Worry
With each passing year, I see and hear the patient’s spiral of worry: Am I getting more forgetful? Perhaps it feels like “Where are my keys?” and “Where did I leave my wallet?” have become common refrains. These are simple memory lapses, an experience most people have throughout their lives, but they can be troubling as we get older.
Testing and Diagnosis
Year after year, for 10 years, in fact, this patient’s cognitive tests had come back normal. Until this year, when a blood test was positive for biomarkers for Alzheimer’s — triggering a further sense of panic.
The Problem with Positive Tests
But here’s the problem: Science can’t yet tell us whether a positive test means the patient has an early stage of the disease. The only new data point was that this patient, so long dreading this day, had positive biomarkers showing increased risk for the disease. This person may not develop full-blown Alzheimer’s for five years or 20 years or ever.
The Medical Community’s Push
There is a sense of urgency in the medical community to classify a positive biomarker test as “Stage One Alzheimer’s Disease.” This is part of a larger desire to appear aggressive in fighting the disease, which for so long had no tests and no course of treatment.
Why Testing Early and Often is Not the Answer
I get that, and I understand why so many older patients fear Alzheimer’s, but I disagree with doctors whose response is to test early and often — and to diagnose Stage One Alzheimer’s based solely on biomarkers.
Conclusion
My stance on widespread testing will be different when doctors have more tools available to predict and treat Alzheimer’s and can offer constructive advice after a blood test comes back positive.
FAQs
Q: Why are biomarker tests becoming more widely available?
A: Biomarker tests are being marketed by companies like Quest and Labcorp, making them commercially available for patients to pay for out of pocket.
Q: What are the implications of a positive biomarker test?
A: A positive biomarker test could lead to unnecessary stress, mental and financial damage, and potentially expensive procedures like MRIs, PET scans, or spinal fluid tests.
Q: Should I get a biomarker test if I’m concerned about Alzheimer’s?
A: Only if you are showing signs of Alzheimer’s disease, such as noticeable changes in mental abilities, personality changes, or new mood symptoms. Consult with a doctor and undergo thorough cognitive testing and a complete review of your medical history.
Q: Can lifestyle changes improve cognitive function?
A: Yes, simple lifestyle changes like exercise, more rest, and healthier eating can improve cognitive function.
Q: What should I do if I test positive for Alzheimer’s biomarkers?
A: Consult with a doctor and undergo thorough cognitive testing and a complete review of your medical history. If you have symptoms, discuss lifestyle changes or treatments with your doctor. If you have no symptoms, monitor carefully and consider participating in research studies.
