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Testing times for the elderly: should there be a national screening programme in the UK for Mild Cognitive Impairment?

Jennifer L Bostock, October 1st 2003

Introduction

In the United States it is estimated that by the year 2050 the number of people with Alzheimer's disease (AD) will increase nearly threefold unless preventative measures are taken.

With our increasingly ageing population in the UK, the Alzheimer’s Society announced that the situation is likely to be similar. AD is a serious problem; it can have profound affects upon the well-being of the sufferers and also their carers, relatives and friends and is a significant drain on NHS resources. Preventing AD should therefore be a NHS priority, however; as yet there is no national screening programme to detect the early warning signs of AD. This article discusses some of the advantages of screening for one such warning sign: Mild Cognitive Impairment (MCI). MCI essentially refers to a loss of short-term memory (for example you remember your wedding 40 years ago but can’t remember what you did this morning) that occurs in old age where other cognitive functions remain intact. Although in itself this memory loss is not necessarily symptomatic of serious disease, it may progress to AD . The good news is that that in future with more research it may be possible, in some cases, to control MCI and so prevent the progression to AD.

Positive advantages of screening for MCI
There are many reasons why screening for MCI might be a good idea. Knowing whether your memory is impaired or not should put your mind at rest and thus ease anxiety - having been tested means that you have made a positive step towards dealing with a problem that may have been worrying you for sometime. It may enable you to exclude other possible reasons for memory loss such as heart disease or diabetes . It may help you and your family to plan for the future. Finding out that you have MCI may motivate you to try and develop social and psychological strategies to cope with current memory problems. Psychologically this in itself may make you feel more comfortable, more confident and motivated, and more in control, which in turn may actually help to improve your memory problems. Furthermore, there is research looking at treatments for MCI. It may therefore be possible to improve memory loss with medication (see Salloway et al 2003 ). Most significantly knowing that there is a ‘problem’ (if there is one) will enable you to seek professional help to try and arrest deterioration and thus perhaps avoid MCI from turning into AD.

As far as the screening itself is concerned, unlike some other national screening programmes (such as mammograms to detect early warning signs of breast cancer), the NHS need not invest in expensive high tech equipment in order to screen for MCI. The initial method of screening for MCI takes the form of relatively simple cognitive and memory tests. It requires no big machinery, nor does it involve any invasive uncomfortable procedures (which may make some people reluctant to attend some screening sessions such as cervical smear testing). This non invasive method of screening for MCI is also less likely to produce inaccurate results (false negatives and false positives) than some other screening methods. New computerised tests such as the Cogtest System are seen to be particularly reliable. Of course there will be some financial expense involved in MCI screening on any large scale, but in the long term it should be cost effective in terms of its potential to prevent the escalation to more serious dementia which currently costs the health and social services significantly.

Conclusion
In conclusion, MCI screening appears better for patients, professionals and the NHS than some screening programmes already sanctioned by the government. If we believe that prevention is better than cure, then we must recognise that the first way to prevent a disease is to establish who is at most risk of getting it. Politically the government is committed both to health promotion, disease prevention and to increasing the NHS budget . The government also recognises that the population is changing and that the elderly play a major role in the future of this country. Surely then it is only a matter of time before we recognise that a national screening programme for cognitive impairment is as important as screening for breast and cervical cancer.

For further information on MCI and Alzheimer’s disease and for national organisations and support groups follow the links on the homepage. If you are aged over 55 and are concerned about your memory then the CNRC are offering a free memory assessment – call 01322 286 862 and quote reference 061.

"Jennifer Bostock is a freelance mental health researcher, writer and academic. She has written for various publications and lectures in both further and higher education. She has postgraduate qualifications in philosophy and social and philosophical psychiatry, whilst her primary research interest concerns philosophical questions in forensic psychiatry. Jennifer is also employed as a mental health service user involvement worker for the South London and Maudsley NHS Trust".

Disclaimer: This article does not necessarily represent, nor necessarily fail to represent the views of the CNRC.

Reuters Health Information Aug 19th 2003
See Waterlow, M. (2001) ‘Mild cognitive impairment may signal early-stage Alzheimer’s disease’ reported on this site March 23 http://www.emental-health.com
See Martyn, C. N. and Gale, C. R. (1999) The British Medical Association Family Doctor Guide to Forgetfulness & Dementia, Dorling Kindersley
There is ongoing research into drug treatments for MCI (Rivastigmine, Galantamine and Donepezil) for example a study by Salloway, S. P. et al (2003) has shown positive results using the drug Donepezil. See Stephen P Salloway., Robert Goldman., Dinesh Kumar., J Ieni., Teresa Griesing and Sharon Richardson Tuesday, 19 August 2003 The Eleventh International Congress ‘Mild Cognitive Impairment: Identification, Progression, and Treatment’ S048-004 Donepezil Treatment Provides Benefits in Patients With Mild Cognitive Impairment http://abstract.confex.com/ipa/11congress/techprogram/paper_2404.htm
The total NHS budget in England will climb from £65.4bn in 2002-3 to £105.6bn in 2007-8 - marking a doubling of its annual budget since 1997. NHS Magazine at www.nhs.co.uk/nhsmagazine September 2003

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