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.