Scientists are working on new tests to assess people’s risk of developing dementia.
- Early diagnosis is
important for all types of dementia.
- The methods researchers
currently use for early detection or screening of dementia can be costly,
not available, or come with certain risks.
- Researchers from
Murdoch University have developed a screening test where people
self-report their concerns in six different cognitive areas to help determine
a person’s dementia risk.
Researchers estimate that more than 55
million people around the world live with dementia.
Dementia is an umbrella term for
diseases affecting a person’s abilities to remember, think, and communicate.
Currently, the most common type of dementia is Alzheimer’s
disease.
With all types of dementia, early diagnosis is important. Although there is currently
no cure for any kind of dementia, early diagnosis helps physicians tap
into medications and other options available to help slow
disease progression.
Over the last few years, researchers
have been working on finding new ways of diagnosing dementia at its earliest
stages.
One such group is from Murdoch
University in Western Australia, where researchers have developed a new test
where people self-report their concerns in six different cognitive areas — such
as memory, concentration, and language — to help determine a person’s dementia
risk.
Their findings were published in the
journal Age and Ageing.
“In the era where disease-modifying
treatments are on the horizon, the earlier we identify those who require
intervention, the better the outcome of such dementia treatment will be,” Hamid R. Sohrabi, BSc, MSc, PhD, executive director of Health
Future Institute, director of the Centre for Healthy Ageing and Professor of
Psychology and Clinical Neuroscience in the School of Psychology at Murdoch
University in Western Australia, and lead author of this study told Medical News Today.
“Current
methods of early detection or screening those at risk of dementia are costly,
not available in most places, and may have certain risks. As such, identifying
those who should move to more medically robust assessments like brain imaging
is critical so that we use our resources in the best way possible.”
— Hamid R. Sohrabi, BSc, MSc, PhD
Focusing
on subjective cognitive decline
To develop this new screening test
called the McCusker Subjective Cognitive Impairment Inventory (McSCI), Sohrabi
and his team focused on measuring a person’s subjective cognitive decline.
Subjective cognitive decline is when
a person self-reports worsening brain functions such as memory loss, confusion,
and thinking.
Previous studies have correlated
subjective cognitive decline to a higher risk for mild cognitive impairment and dementia, as well as
Alzheimer’s disease progression.
“Subjective cognitive decline
increases the risk of dementia by about two-fold,” Sohrabi explained.
“However, the measures available in
the field were not robust enough to be used in clinical practice and with
individuals. As such we work very hard to develop a measure that can be used in
both research and clinical practice and with outstanding accuracy. We were very
confident at the beginning (that) the McSCI (would) be a great measure but it
did far better than we expected when we finalized the statistical analysis on
it,” he said.
How
does the McSCI screening tool for dementia work?
The McSCI screening test is a
46-item, self-reporting questionnaire that allows a person to address their
concerns in six cognitive areas:
- memory
- language
- orientation
- attention and concentration
- visuoconstruction abilities
- executive function
During the study, researchers found
the McSCI screening tool can identify individuals with above-average levels of
subjective cognitive decline with a 99.9% accuracy.
“It is a questionnaire (that) should
be completed under a clinician’s supervision as the score could be misleading
for those without such education and expertise,” Sohrabi said. “The higher the
score on the McSCI, the more concerned one is (about) reporting their cognitive
abilities.”
“Memory complaints are important and
should be considered seriously,” he continued. “However, the McSCI does not ask
only about memory. It does ask about several cognitive functions that our
research and others have shown to be important. In addition, it does provide
(a) cut of scores for general practitioners and clinicians that can help to
decide whether they should do any further assessments on their patients.”
Additionally, researchers developed
the McSCI to be open access, allowing it to be used by doctors and researchers
at no cost.
“We are working on an informant
version of this measure and also on online apps that can further facilitate the
use of the McSCI, if we get further funding available to us,” Sohrabi added.
Breaking
through the brain health bottleneck
After reviewing this study, Karen D.
Sullivan, PhD, ABPP, a board-certified neuropsychologist, owner of I
CARE FOR YOUR BRAIN, and Reid Healthcare Transformation Fellow at FirstHealth
of the Carolinas in Pinehurst, NC, told MNT that
we have a massive bottleneck in the worldwide healthcare system with not enough
brain health specialists and the largest aging population in world history at
risk for the neurodegenerative diseases who need early and accurate dementia
diagnoses to benefit from current treatments.
“We need innovative solutions to this
public health crisis,” Sullivan continued. “Standardized, sensitive, and
predictive self-reports like the McSCI are an important element of a screening
procedure, but we also need to integrate them with reports from someone who
knows the person well and can share their observations of any cognitive, behavioral,
and functional change and cognitive assessments to rate brain function in
action.”
“I’d like to see how the McSci correlates with future diagnosis of the different dementia subtypes. I predict it may be inversely related to Alzheimer’s disease specifically. In my clinical experience as a neuropsychologist, the less subjective complaints about cognitive decline, the more likely it is Alzheimer’s.”— Karen D. Sullivan, PhD, ABPP
Further research required
MNT also spoke with Jasdeep S. Hundal, PsyD, ABPP-CN, director of The Center for
Memory & Healthy Aging at Hackensack Meridian Jersey Shore University
Medical Center and associate professor of psychiatry and neurology at
Hackensack Meridian Health School of Medicine in New Jersey, about this study.
Hundal commented his initial reaction
to this study was one of cautious enthusiasm.
“The introduction of a well-validated
self-report measure like the McSCI-S could be a useful tool in early detection
and treatment,” he explained. “I also appreciate the study’s comprehensive
approach in developing and validating the McSCI-S. Its excellent internal
consistency and significant associations with established objective cognitive
measures underscore its potential utility in both clinical and research
settings.”
“This enthusiasm is tempered with
caution,” Hundal continued. “First, the reliance on self-reported data, while
valuable, can be susceptible to various biases. Factors such as suboptimal
awareness of deficits, mood disorders, personality traits, and the inherent
subjectivity of self-assessment can impact the accuracy of the McSCI-S.
Moreover, the cut-off score of ≥24, although chosen for its high sensitivity,
has relatively low specificity, raising concerns about false positives. These
issues may impact the integration of the McSCI-S into clinical practice.”
Hundal suggested next research steps
include validation studies with more diverse populations and across different
geographical areas, as well as longitudinal studies to track patients over a
longer time frame.
“Another important step could be
correlating the McSCI-S results with additional objective measures, like
Alzheimer’s disease biomarkers,” he added.
“Integrating
subjective assessments with objective biological markers could enhance
diagnostic accuracy and provide a more comprehensive understanding of the
cognitive changes associated with Alzheimer’s.”— Jasdeep S. Hundal, PsyD,
ABPP-CN
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