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A Simple 3-Part Test May Predict Alzheimer’s

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3 Star

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A Simple 3-Part Test May Predict Alzheimer’s

Our Review Summary

If only diagnosing Alzheimer’s disease were as “simple” as stories like this suggest. We had some issues with the way the study results were characterized:

  • The first sentence notes that Alzheimer’s begins developing years — perhaps decades — before the onset of symptoms, suggesting that the new test might be useful for making a very early diagnosis. But the story never notes that the study being covered was conducted in individuals age 70-89, and that it followed participants for only five years. 
  • Like many stories about screening tests, no potential harms are discussed and the only person interviewed was one of the study authors.
  • The presumed benefits of the testing are not adequately quantified, nor is the reader provided with any actual data or examples.  
  • The story cautions about the need for additional research, but also quotes one of the authors suggesting that the tests should be conducted for every patient over the age of 65 — advice that smacks of scare-mongering.  

 

Why This Matters

Long-term research suggests that mild cognitive impairment (MCI) may affect 10 to 20 percent of people aged 65 and older. But mild cognitive impairment is not the same thing as Alzheimer’s disease (AD) — here’s a post describing the difference. The National Institutes on Aging says it’s not certain how many of those affected by MCI will go on to develop Alzheimer’s Disease, but it is believed to be a precursor to AD for some. Because the potential for cognitive impairment produces anxiety for readers of a certain age, stories have an obligation to be very careful with these terms.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The story does note that current, more sophisticated methods of testing are expensive. But it doesn’t really address the cost of new test, except to imply that it would be cheaper. That may well be true, but the cost of adding a separate battery of tests to every patient 65 years and older, as the story suggests, could be enormous. The “simple” tests defined in the research involve a detailed medical and social history as well as standardized testing for anxiety and depression and gait.  This testing along with interpretation takes time, and in today’s environment, time is money.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

We give the story credit for pointing out that there are few if any meaningful interventions available for MCI, and the testing may be useful in the future to identify patients who might benefit. But we have some concerns.

Our first issue with the story is the emphasis on the early diagnosis of Alzheimer’s disease.  The study was actually directed at early identification of mild cognitive impairment and not Alzheimer’s per se.  The distinction is important. Although many people with mild cognitive impairment go on to full blown Alzhemier’s, not all do.

Our second problem with the story is the lack of any meaningful quantification of the results. The story notes, “…those who scored higher on the test of risk factors had a seven-fold higher chance of developing mild cognitive impairment than those with lower scores.” That doesn’t really tell us anything useful about the test results. As a reader, I want to know how good is the test at predicting whether I’m going to be impaired? As it turns out, the “7-fold increase” is not as definitive as suggested by the story. For example, a 70-year-old man with the highest score in the tests has a 1 in 4 chance of developing mild cognitive impairment in the next 5 years.  That same individual would have about the same risk of a major cardiac event based on the American Heart Association risk calculator. So individuals who score highly on the test are hardly condemned to develop Alzheimer’s, or even mild cognitive impairment. The story would have done well to communicate that fact to readers.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

Being told you are at increased risk for developing cognitive impairment is potentially distressing news. But as with many new reports on screening for disease, absolutely no mention is made of the potential harms associated with the tests.  And what about the potential for false alarms? Unnecessary emotional anxiety, increased doctor visits, and drug interventions could potentially have a very negative impact on someone who is experiencing normal aspects of aging.

Does the story seem to grasp the quality of the evidence?

Satisfactory

We are on the fence on this one, but we’ll give the story the benefit of the doubt.

The story does give an effective description of how the study was done, and it points out that the tests described are a “potential” solution and that confirmatory studies need to be performed.  It also points out that the only way to truly diagnose Alzheimer’s is through examination of spinal fluid or expensive imaging.

But the story headline, “A Simple 3-Part Test May Predict Alzheimer’s,” and its sub-head suggesting there’s “a new test that any physician can perform in their office” give an over-optimistic and inaccurate representation of the research and its implications. The 3-part testing process involves detailed patient histories, a psychiatric evaluation, a test of motor skills and a blood test to identify the presence of a specific gene associated with Alzheimer’s Disease. That’s not exactly “simple.”

We’re also concerned that the story allows an expert to suggest “that every physician should get this information on their patients at age 65; that way, they can have a baseline against which to compare any changes as their patients age.”  Even though the story later knocks that statement down, why even suggest it if the research isn’t yet ready for prime time? We’ll flag the story for this below in the Disease Mongering section.

Does the story commit disease-mongering?

Not Satisfactory

While we give the story credit for not providing the reader with ominous statistics about the incidence of Alzheimer’s or mild cognitive impairment, the suggestion that everyone over the age of 65 should have this testing certainly pings our scare-mongering radar. As does the story’s inaccurate suggestion that a high score can help diagnose Alzheimer’s disease, when it’s really only indicative of mild cognitive impairment. As does the failure to put a “7-fold increase in risk” in the appropriate overall perspective, as discussed above under Benefits.

Does the story use independent sources and identify conflicts of interest?

Not Satisfactory

The story provides quotes and comments by one of the authors of the study. An independent expert would likely have identified many of the coverage gaps we discuss in this review. HealthNewsReview.org provides a list of independent experts who are willing to talk with journalists who need help fleshing out their stories.

Does the story compare the new approach with existing alternatives?

Satisfactory

The story points out that other methods of testing are available for Alzheimer’s disease including sophisticated scanning and genetic testing. We’ll award a satisfactory rating on that basis. However, we’d note that the story does not point out that many of the tests used in the study are currently used to diagnose mild cognitive impairment and are already used by primary care physicians and others.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

Although not explicitly stated, the story makes it clear that the test could be performed now. That’s technically accurate, and we’ll award a satisfactory on that basis. However, we wonder how many general practice clinics are equipped both staff- and resource-wise to begin testing their patients. Even without the need for “new technology and expensive equipment,” as stated in the article, one assumes clinics and hospitals much smaller than the Mayo Clinic (which developed the test procedures) would require at least some training and additional resources in order to introduce multi-part testing.

Does the story establish the true novelty of the approach?

Satisfactory

The story notes that the elements used in the rating scale have not been combined in this way previously and that the test overall is new

Does the story appear to rely solely or largely on a news release?

Satisfactory

The quotes used in the story are different from those found in this news release so we can be sure the story includes an interview with the study author.

Total Score: 5 of 10 Satisfactory

Comments (1)

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Susan Molchan, MD

March 23, 2015 at 6:23 pm

In the abstract of the study, the authors note, validation in independent samples will be required. Yes it will. Including from the group that ran this study. The primary author, Dr. Petersen, essentially “invented” the concept to MCI, so he is very heavily invested in the idea. A significant number of people diagnosed w/ MCI in prior studies, “reconverted” to normal, at least for a time.
Also note that the only way to truly diagnose Alzhiemer’s remains at autopsy–and some pathologists may even fight about some cases there. Especially early on, the spinal fluid tests and imaging have a lot of overlap with those who don’t have dementia, or have other causes of their dementia.

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