Family Detect Alzheimer's Signs Better than Common Tests

Washington University School of Medicine researchers have found that traditional screening tests aren’t as sensitive to the early signs of Alzheimer’s dementia as are family members and close friends of the person suspected of having memory problems.

Reporting in the journal Brain, the researchers validated their own two-minute Ascertain Dementia 8 (AD8) questionnaire—which relies on a friend or family member, an informant, who knows the person well to evaluate whether cognitive changes might be behind the individual’s difficulties in performing activities of daily living—to “see if it could highlight individuals who had biological indicators, or biomarkers, for Alzheimer's disease, such as abnormal levels of certain factors in the spinal fluid or positive brain scans for Alzheimer's plaques.”

They found that results from AD8 more consistently corresponded with biomarker results than did results from traditional cognitive tests, such as recalling a list or words or comparing object shapes.

"It's not economically feasible to screen everyone for Alzheimer's disease biomarkers," said John C. Morris, MD, Harvey A. and Dorismae Hacker Friedman Distinguished Professor of Neurology, and director, Charles F. and Joanne Knight Alzheimer's Disease Research Center, Washington University School of Medicine. "The AD8 gives us a brief and very low-cost alternative that takes a few minutes of the informant's time to screen for dementia and thus identify those individuals who need follow-up evaluations to determine if there truly are signs of Alzheimer's."

With traditional early-stage dementia screening tools providing a snapshot of one’s cognitive abilities only during the time in which they’re being test, and the inability of many people with early-stage dementia to assess their own problem, the researchers developed AD8 with the hope that informants could provide solid insight into the patient’s mental state by responding “yes” or “no” to he following:

• Problems with judgment, such as bad financial decisions;
• Reduced interest in hobbies and other activities;
• Repeating of questions, stories or statements;
• Trouble learning how to use a tool or appliance, such as a television remote control or a microwave;
• Forgetting the month or year;
• Difficulty handling complicated financial affairs, such as balancing a checkbook;
• Difficulty remembering appointments; and
• Consistent problems with thinking and memory.

Each corresponding “yes” is worth one point, and two points indicate the need for additional evaluation.

"These informants can give us the retrospective perspective we need to know that a person's mental abilities have begun to meaningfully decline, indicating that additional testing is needed," Morris said. "Based on our results, the AD8 appears to be superior to conventional testing in its ability to detect signs of early dementia. It can't tell us whether the dementia is caused by Alzheimer's or other disorders, but it lets us know when there's a need for more extensive evaluations to answer that question."