Assessing the ‘Worried Well’ - Online Memory Testing Tools

by Women's Brain Health Initiative:As we age, it is normal to experience some decline in our memory function. But with so much public concern about the ever-increasing prevalence of dementia, many of us wonder if our forgetfulness is a sign of something more ominous, even if those fears are usually misplaced. In the past, physicians had often dismissed the memory-related complaints of otherwise healthy individuals as the hypochondria of the so-called ‘worried well.’ But feeling that one’s thought processes are waning could be a sign of something real, and may require further investigation.“We don’t have easy measures for what’s normal or not [with memory loss]. It’s not like taking your temperature for a fever,” explained Dr. Angela Troyer, the Professional Practice Chief of Psychology and the program director of Neuropsychology and Cognitive Health at Toronto’s Baycrest Health Sciences. “It’s a reasonable worry.”Now the worried will have access to resources that can tell them whether they really have something to be concerned about, without the necessity of seeing a doctor.THERE ARE A VARIETY OF ONLINE TESTS THAT CAN DETERMINE, WITH A HIGH DEGREE OF RELIABILITY, WHETHER AN INDIVIDUAL IS TRULY SHOWING SYMPTOMS OF DEMENTIA THAT SHOULD CAUSE HIM OR HER TO CONTACT A MEDICAL PROFESSIONAL.Such online tests can save a considerable amount of time and stress for both patients and the healthcare system.A definitive diagnosis of dementia can be a complex matter, involving several specialists conducting a battery of tests. It might start with a general practitioner who, if he or she has some expertise in the field, can make a relatively quick assessment. But for less obvious cases of cognitive decline, a geriatrician might be consulted, along with a neurologist and a neuropsychologist who might order blood work and brain imaging, as well as verbal and written tests.IN SOME CASES, MEMORY LOSS AND CONFUSION CAN BE CAUSED BY PROBLEMS OTHER THAN DEMENTIA.Anxiety, sleep apnea, chronic stress, depression, diabetes, and side effects from medications and chemotherapy can all impact one’s ability to focus, pay attention, and remember. Additionally, a deficiency in vitamin B12 or a urinary tract infection can lead to similar symptoms and, unlike Alzheimer’s disease, can be treated.At the end of a rather exhaustive medical process, the verdict might be that the patient is suffering from nothing more than the average level of memory loss – in which case, he or she is a member of the worried well cohort.It is for this segment of the population that Baycrest and other health care institutions developed online tests to try to establish an accessible way for those with significant memory concerns to determine whether they may be suffering from actual symptoms of dementia.“That was the motivation – can we help people to give them some feedback to know what’s normal and what’s not,” said Dr. Troyer in an interview with Mind Over Matter®. Such tests are not a clinical diagnosis, but rather a screening process to help facilitate earlier assessment, diagnosis, and treatment.Co-developed by the brain health solutions company Cogniciti Inc. (owned by Baycrest and partner MaRS Discovery District), the Cogniciti™ is a free, online brain health assessment comprised of a series of game-like mental challenges that tap into memory and attention performance. Test-takers receive a cognitive health score upon completion that indicates where they rank compared to other adults with the same age and level of education. Those who score in the low range are encouraged to print their report and take it to their doctor to start the conversation about their memory concerns. Those who score in the normal range are directed to helpful information about maintaining brain health.FOR COGNITION, WHAT’S NORMAL VARIES A LOT,” SAID DR. TROYER. “WE KNOW SOME PEOPLE HAVE GOOD MEMORIES, SOME HAVE BAD MEMORIES.According to the test’s creators, the majority of people will score in the normal, healthy range for their age – which will help reassure the worried well.Prior to its launch in 2014, the developers conducted a study of 400 middle-aged and older adults who had no diagnosis of serious memory problems. The Cogniciti™ team compiled a series of tasks that are sensitive to changes in memory and, working with IT advisors, adapted it to the online environment. The test group performed the various tasks, giving the developers baseline scores to help them determine a cut-off point below which a person could be said to have an issue with memory and attention. The results were published in a peer-reviewed journal before Cogniciti™ was made available to the public – a key point, said Dr. Troyer, for anyone searching for an online dementia test.“The most important thing people should look for is whether it’s been validated scientifically. Any valid one would have a link to a validated study,” Dr. Troyer observed.There are a variety of different products on the market, some of which charge a fee and some of which have not necessarily been well-researched and therefore may not be a good gauge of potential dementia symptoms. However, there is scholarly research to support the notion that a properly-developed test can be helpful for screening purposes.The Self-Administered Gerocognitive Examination (SAGE) test, developed by the Ohio State University College of Medicine, is another reliable cognitive assessment tool used to identify individuals with mild cognitive impairment or early dementia. A 2017 study published in the journal Alzheimer’s Research & Therapy compared the digital format of the test (eSAGE) with other neuropsychological tests, as well as clinical assessments of cognitive impairment, and found a “high sensitivity and specificity in detecting cognitive impairment from normal subjects.” The study concluded that eSAGE would be valuable in helping to identify early changes in cognition that could be warning signs of dementia.To date, the Cogniciti™ brain health assessment has been completed nearly 65,000 times and more than 270,000 people have visited the website. Baycrest is currently conducting a follow-up study to confirm the validity of the Cogniciti™ test. Researchers are working with two groups of participants, one of which includes individuals who have memory impairment and one without. While Dr. Troyer is pleased with the results to date, she does not expect online tests to move beyond screening purposes to give an accurate diagnosis of dementia.“Some clinical judgement is involved. I don’t know whether that could be automated.”Source: MIND OVER MATTER V7