It’s an increasingly common problem — someone you care about seems to be showing signs of cognitive slippage, but you’re not sure whether it’s serious enough to merit testing or not. Should you schedule an appointment to see what the doctor thinks?

Not so fast. It turns out that the best person to judge whether or not there’s a real reason to worry may not be a medical professional but a family member or close friend, a recent study shows. If this doesn’t seem particularly surprising to you (after all, who better to evaluate changes in cognitive function than those who know a person best?), you may still find the study results startling—because a standard screening test used by health professionals to detect dementia was so much less effective in recognizing serious situations than the observations of family and friends.

Researchers at Washington University School of Medicine in St. Louis wanted to see which of two tools to identify early-stage dementia worked better. One, called the Ascertain Dementia 8 (AD8) questionnaire, consists of an eight-question survey that is completed by a family member (usually the spouse or an adult child) or a friend of the person whose cognitive function is in question. The other is the commonly used Mini Mental State Exam (MMSE), a more detailed dementia screening test that is administered to the patient by a health-care professional. Researchers compared the results when both tests were used to evaluate 257 individuals (average age 75.4 years), some of whom were cognitively normal while others had mild Alzheimer’s symptoms. Then they examined these people using imaging and spinal fluid tests that identify Alzheimer’s changes in the brain, such as amyloid plaque. Although there were some “false positive” results, the AD8 questionnaire (the one done without using a doctor) picked up all but five of 101 individuals with dementia… while the MMSE test missed 74 of these mildly affected individuals!

Moreover, the AD8 is free, noninvasive and easy to complete in just a few minutes.

John C. Morris, MD, director of The Charles F. and Joanne Knight Alzheimer’s Disease Research Center at Washington University School of Medicine, who was involved in the research, said that the AD8 questionnaire itself is not a diagnostic instrument but a reliably sensitive screening tool to determine the need to seek definitive diagnostic evaluation for Alzheimer’s. “Instead of just saying, ‘Dad’s not really remembering to pay the bills like he used to,’ this questionnaire can give you a way to structure your concerns and then present them to your physician,” he said.

HERE’S THE TEST

To administer the questionnaire, answer the following yes-or-no questions regarding the loved one you’re concerned about. Two or more “yes” answers may mean that further diagnostic testing is in order…

Over the last several years, have you noticed a change in cognitive abilities for your loved one in regard to:

  1. Having problems with judgment (e.g., problems making decisions, bad financial decisions, problems with thinking).
  2. Showing less interest in hobbies/activities.
  3. Repeating the same things over and over (questions, stories or statements).
  4. Having trouble learning how to use a tool, appliance or gadget (e.g., computer, microwave, remote control).
  5. Forgetting the correct month or year.
  6. Having trouble handling financial affairs (e.g., balancing a checkbook, income taxes, paying bills).
  7. Having trouble remembering appointments.
  8. Having daily problems with thinking and/or memory.
If you answered yes to two or more questions, don’t panic — Dr. Morris stresses that the AD8 isn’t a diagnostic tool, but one that is meant to determine whether more testing should be done. To families facing uncertainty about what to do about a loved one who seems to be declining, this looks like a safe, wise and supportive first step to take.
Reprinted with permission. Copyright 2005. The AD8 is an experimental tool and not a substitute for clinical judgment.