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Published on: March 30, 2011
by Sharon Tanenbaum for Everyday Health:
What did you do for Thanksgiving last year? Where did you go on your honeymoon? Starting at 100, count backward by seven. Remember the following three-word sequence: truck, cabin, spoon.
These are among the series of questions Derek Shepherd and Meredith Grey are asking of Alzheimer’s disease patients to determine whether they’re qualified for entry into a clinical trial on this season’s Grey’s Anatomy.
But if you’re sitting on the couch five minutes later struggling to remember the word “cabin,” should you worry about your own brain health? And just how accurate is such a test at gauging Alzheimer’s disease risk? Everyday Health asked leading memory experts for answers.
What the Grey’s Memory Tests Means
Although the test used on the TV show is not identified by name, some of the questions, like the three-word memory sequence and counting back directive, are included in the Folstein Mini Mental State Examination (MMSE), a 30-point questionnaire introduced in 1975.
“It’s the most commonly used cognitive evaluation for memory loss,” says Cynthia Green, PhD, assistant clinical professor of psychiatry at Mt. Sinai School of Medicine in New York City. “It’s a screening test, so it doesn’t delve deeply into someone’s mental functioning across different areas of intellectual performance.” (Other types of MMSE questions include drawing certain pictures and performing a three-step command, such as “take a piece of paper, fold it in half, and place it on the floor.”)
Keep in mind that the questions used by Derek and Meredith in their fictional version of the test are just a sampling of the total number of questions that would be used in a real test. Otherwise the limited number of answers wouldn’t tell clinicians much. The questions portrayed on TV are such a small snippet that the results are not that significant for the average person, says Dr. Green. And the question of whether a patient can remember where she spent her honeymoon isn’t likely to be on a real test: “That’s more of a remote memory, which is usually retained until later stages of the disease,” Green notes.
Senior Moments vs. Real Red Flags
So why can’t you remember the above word sequence or where you parked the car at the supermarket? You probably just weren’t paying attention, or you were multitasking or just plain distracted. Such everyday “senior moments” aren’t enough to raise a red flag for dementia, says Green.
“Everybody forgets things once in a while. It’s important to forget, otherwise think how awfully full your brain would be. You wouldn’t be able to sleep at night,” says Laurel Coleman, MD, a geriatric physician in Augusta, Maine, and national board member of the Alzheimer’s Association.
What is concerning, according to Green: “When a change in memory lasts for four to six months, impairs your ability to function independently at work or at home, and if your family and friends notice a change in your abilities or behavior.” If you or a loved one experience any of these symptoms of possible dementia, you should talk to your doctor and get evaluated.
Even then, keep in mind that memory loss doesn’t automatically mean you have Alzheimer’s, which counts language problems, disorientation, and face-recognition issues among its other symptoms. “Memory loss can be a symptom of at least 75 different medical conditions,” says Green, including a vitamin B12 deficiency, thyroid disorders, emotional distress, depression, and side effects from medication.
Alzheimer’s is the most common form of dementia, accounting for about 70 percent of cases in people age 71 and older. But it strikes only five percent of people between 65 and 74. The younger you are, the more likely a memory-related issue is something other than Alzheimer’s.
“We worry so much about memory loss because it’s something we’re afraid of,” says Green. “But since there are so many different things that can cause it and many of those conditions are reversible, it’s important to seek evaluation, and to do it sooner rather than later.”
The Role of Memory Tests in Real-Life Alzheimer’s Studies
Diagnosing Alzheimer’s disease is challenging, since the only way to definitively determine the presence of disease is by looking at brain cells after someone has died. Instead, doctors evaluate the likelihood of Alzheimer’s with a variety of tests that also seek to rule out other possible causes of dementia.
These can include a thorough medical history, complete physical examination, lab tests of blood, urine, and sometimes spinal fluid, and brain scans, in addition to cognitive testing. Doctors at specialized Alzheimer’s treatment centers can diagnose the disease with 90 percent accuracy, according to the National Institute on Aging.
During the cognitive tests, clinicians check on a wide range of brain functions — assessing not just memory— but a patient’s calculation ability, attention, insight, judgment, and how they prioritize things, says Dr. Coleman. “We examine a variety of things because people think in so many different ways.”
Clinical Trials for Alzheimer’s Disease
The fictional Grey’s Anatomy clinical trial highlights the importance of real-life research: According to the Alzheimer’s Association, there currently are more than 100 Alzheimer’s clinical trials that need 50,000 volunteers — with and without the disease — to participate. Such trials are studying new ways to detect, treat, and prevent Alzheimer’s and related types of dementia.
Although researchers can’t offer regular mental state exams by Dr. McDreamy, if you or a loved one is coping with an Alzheimer’s diagnosis, consider finding a study that may be right for you through the Alzheimer’s Association Trial Match program or on ClinicalTrials.gov. Research shows that people involved in studies tend to do somewhat better than people at a similar stage of Alzheimer’s who are not enrolled in trials, the association says.
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