How to Detect Dementia

Dementia is common. You might think that doctors and neuropsychologists would have a good understanding of how to detect it. Judging from a recent New York Times article, they don’t. The article is based on a study that found that people who report memory problems not detected by a standard test turn out to be more likely to end up with dementia (measured by a standard test) than those that don’t. This isn’t surprising; what’s more revealing is how people who report memory problems have been treated in the past: their complaints have been dismissed. For example:

Patients like this have long been called “the worried well,” said Creighton Phelps, acting chief of the dementias of aging branch of the National Institute on Aging. “People would complain, and we didn’t really think it was very valid to take that into account.”

Doctors had no idea whether these complaints were valid but rather than admit this ignorance they . . . confabulated. They claimed, based on nothing, that the complaints were not valid. It reminds me of a surgeon telling me that research supported her claim that I needed surgery (for a hard-to-notice hernia). No such research existed. When I asked her what research? she said she would find it. She was bluffing, in other words. That’s just one doctor making up evidence. Here it has been a whole group of doctors.

The problem isn’t just confabulation. Apparently doctors in this area fail to understand basic principles of measurement. When Patient Y visits Doctor X and complains of memory problems, Doctor X gives Patient Y a series of memory tests. Only if Patient Y scores below normal range does Doctor X think that Patient Y’s complaint is “real”. For example:

The man complained of memory problems but seemed perfectly normal. No specialist he visited detected any decline. “He insisted that things were changing, but he aced all of our tests,” said Rebecca Amariglio, a neuropsychologist at Brigham and Women’s Hospital in Boston. 

Amariglio apparently fails to understand that a series of measurements on one person — which is what the man’s complaint was based on, comparing himself now to himself in the past — is going to be vastly more sensitive to change than a comparison of one person to other people. A reasonable response to a complaint of memory loss would be: This is hard to detect with a one visit. Let’s give you a sensitive test and have you come back in six months to see if you decline more than normal. Judging from the Times article, doctors still haven’t figured this out.

Speaking of memory decline, Posit Science still hasn’t sent me the data they promised to send me.

Thanks to Alex Chernavsky.

7 Responses to “How to Detect Dementia”

  1. dearieme Says:

    I find myself struggling to remember familiar names. Last week it was “hollyhocks”, this week it was – oh bugger, I can’t remember.

    Seth: The more you know the harder it will be to recall one thing correctly — there is more interference from everything else you know. Increasing memory problems with age may or may not be due to memory decline.

  2. Charlie Says:

    My 94 year old mother has always complained about not being able to remember things, although she remembers lots of things from her childhood. A few years ago she really started complaining and I even noticed she was a little more forgetful. So I took her off her statin meds and started feeding her butter – a pound a week. Her memory is back to where it was when she only thought she couldn’t remember.

    She is also in brighter spirits, more active and engaged.

    Charlie

  3. Evelyn M. Says:

    As medical science doesn’t know what to do about memory loss, even if physicians acknowledge it is occurring, there is no point in taking that problem to a physician. This should be made common knowledge, just as people should be told that it is useless to visit a physician when you have a cold or the flu.

    I can no longer keep up with story lines in modern films, but I think that is due to the poor quality of movie production and direction nowadays, not a loss in my own abilities. If I watch a film I haven’t seen before dating before the 1970s, I have no trouble whatsoever in following the plot. Also, films in the “good old days” actually let you hear the dialogue – no music hindered the sound of speech, while nowadays dialogue in films is usually overshadowed by loud music and sound effects.

    I read somewhere that a good test for when a woman is losing her mental capabilities is whether she can still put a complicated meal together. We have proper family dinners every week, and I am able to serve everything on time and cooked correctly, so I’m not too worried about occasional lapses in remembering people’s names! First things first.

  4. Alex Chernavsky Says:

    Evelyn, I think that modern movies and TV shows are far more complicated than they used to be:

    During its 44 minutes — a real-time hour, minus 16 minutes for commercials — the episode (of Fox TV show “24”) connects the lives of 21 distinct characters, each with a clearly defined ”story arc,” as the Hollywood jargon has it: a defined personality with motivations and obstacles and specific relationships with other characters. Nine primary narrative threads wind their way through those 44 minutes, each drawing extensively upon events and information revealed in earlier episodes. Draw a map of all those intersecting plots and personalities, and you get structure that — where formal complexity is concerned — more closely resembles ”Middlemarch” than a hit TV drama of years past like ”Bonanza.”

    For decades, we’ve worked under the assumption that mass culture follows a path declining steadily toward lowest-common-denominator standards, presumably because the ”masses” want dumb, simple pleasures and big media companies try to give the masses what they want. But as that ”24” episode suggests, the exact opposite is happening: the culture is getting more cognitively demanding, not less. To make sense of an episode of ”24,” you have to integrate far more information than you would have a few decades ago watching a comparable show. Beneath the violence and the ethnic stereotypes, another trend appears: to keep up with entertainment like ”24,” you have to pay attention, make inferences, track shifting social relationships. This is what I call the Sleeper Curve: the most debased forms of mass diversion — video games and violent television dramas and juvenile sitcoms — turn out to be nutritional after all.

    http://www.nytimes.com/2005/04/24/magazine/24TV.html?_r=0

  5. Evelyn M. Says:

    Thank you for the comment, Mr. Chernavsky. Happily, “24″ was so brilliantly produced and directed (not to mention scripted and acted) that I had absolutely no trouble following it! We are all looking forward to the new season that we’ve been told will begin in 2014.

  6. Andrew Says:

    A bit off topic (although a bit related to dementia), but I haven’t seen whether you’ve expressed any views about the fish oil/prostate cancer study. I’ve been taking omega 3 supplements for some time (both for brain function and cankersores) and a number of people have advised me to stop as a result of the study. I am personally skeptical of the study, but was curious if you have any thoughts.

    Seth: The study made me glad I take flaxseed oil rather than fish oil. It’s epidemiology, usually a bit hard to interpret. I take flaxseed oil because of experimental data I gathered on myself — much better evidence, if I want to know what’s good for me.

  7. Kyle Lee Says:

    1. I think 1 thing with the Fish Oil study is that they looked at 1 factor. Maybe they were pre-disposed to having more health problems which led them to take the fish oil. Also they didn’t look at the quality or dosage of the supplements.

    2. Seth have you ever experimented with replacing flaxseed oil with fish oil?

    Seth: Long ago I thought I would try fish oil in place of flaxseed oil but other things have kept getting in the way. The one time I tried fish oil it gave me a headache. I have some in my refrigerator now, however.