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VA HOSPITALS HELP IDENTIFY EARLY DEMENTIA --

Researchers say they've found nearly twice as many

cases of "cognitive impairment" as they expected.

Maria Cofrancesco, center, the VA Medical Center’s dementia care coordinator, tested John Wagner’s balance during a follow-up visit to the center. During an earlier visit to the center with his daughter, Lisa, left, he was found to have the disease. (photo: Bruce Bisping, Star Tribune)

For more information about dementia, use the VA Watchdog search engine ... click here ...
http://www.yourvabenefits.org/sessearch
.php?q=dementia&op=and

Story here... http://www.startribune.com/lifestyle/h
ealth/27077844.html?elr=KArksLckD8EQDUoaEyq
yP4O:DW3ckUiD3aPc:_Yyc:aUUJ

Story below:

-------------------------

Dementia: Memorize these three words ...

By MAURA LERNER, Star Tribune

The test sounds simple enough:

Memorize three words, draw a clock and repeat the words a few minutes later.

Since October, some 4,000 volunteers age 70 or older have taken that test as part of an experiment at the VA Medical Centers in Minneapolis and several other cities.

About a fourth of them have failed.

Of that group, most turned out to have some form of dementia, said Dr. J. Riley McCarten, an Alzheimer's disease specialist leading the experiment.

The test is part of an unusual two-year demonstration project that McCarten and his team designed to try to identify and help people in the earliest stages of Alzheimer's disease.

So far, they've found nearly twice as many cases of "cognitive impairment" as they expected, says McCarten, a neurologist and medical director of the aging clinic at the Minneapolis VA hospital. Often, he said, neither the patient nor the family realized the problem was that serious.

"They may honestly not recognize that they're forgetting things," said McCarten. "Sometimes families rationalize problems: 'Dad's 80. He's forgetful. What do you expect?'"

In medical circles, the idea of randomly screening groups of people for dementia has been quite controversial, partly because of concerns about false alarms and stigmas.

But McCarten believes that patients are better off knowing sooner than later. So he has created a network of experts -- known as "dementia care coordinators" -- at a handful of VA hospitals to search for new cases and to help families cope with the diagnosis.

The first step is usually the memory-and-clock test, known as the "Mini-cog."

Maria Cofrancesco, one of the dementia care coordinators, looks for patients 70 or older going to the Minneapolis VA for routine checkups, and asks if they would mind taking a five-minute memory test.

They are asked to memorize three unrelated words (i.e. banana, chair, sunrise); then, partly as a diversion, to draw a clock with a specific time. Now, can you repeat the words?

A surprising number can do neither.

The test, designed by a University of Washington psychiatrist, Dr. Soo Borson, is seen as a first alert. When someone fails, said Cofrancesco, "I say 'the score suggests that you may or may not have a memory problem.'" She invites them back for a two-hour battery of follow-up tests.

So far, McCarten reports, more than 90 percent of those who return for the follow-up have "some level of cognitive impairment that was not previously recognized."

An unexpected diagnosis

Lisa Wagner had noticed that her 82-year-old father, John Wagner, of Edina, was having trouble finding words and was a little forgetful. But she chalked it up to the lingering effects of a stroke years back.

In January, her dad, a retired Honeywell executive and World War II vet, agreed to take the VA's memory test. In this case, Cofrancesco decided to skip the quick test and go straight to a full workup, because of his occasional memory lapses.

Wagner, still vigorous and quick witted, had little trouble with some parts of the test, such as counting backwards from 100.

But he struggled with others: recalling the names of certain animals, for example, or repeating a series of hand motions.

When Cofrancesco showed him the results, he was stunned. The diagnosis: early Alzheimer's disease. "I kind of thought I was misdiagnosed," he later recalled. "I never thought I'd get Alzheimer's."

Lisa, the eldest of his five children, was with him when he got the news. "I said 'Dad, nothing changed. ... You're the same as when you came in. Someone just labeled it.'"

Then Wagner, his family and Cofrancesco set out to answer the question: What happens next?

Worrying about stigmas

"It's really pioneering, what they're doing," said Michelle Barclay, a vice president at the Alzheimer's Association of Minnesota and North Dakota. The problem now, she said, is that many cases of dementia go unrecognized until a crisis hits -- a diabetic forgets to take her insulin, for example, and lands in the hospital.

"This demonstration study is looking at what if we actually catch these people and manage their care well," she said. "If people are diagnosed earlier in the illness ... they are less likely to have crisis after crisis after crisis."

Not everyone, though, is convinced that widespread testing is the answer.

"We have to be a little bit cautious," said Dr. Malaz Boustani, a dementia researcher at Indiana University. Last year, he published a report in the Journal of the American Medical Association challenging the whole idea, noting that it would be a huge expense to test everyone past a certain age. "Before screening can be advocated," he and his colleagues wrote, "there must be evidence that the benefits outweigh any potential harm."

The downside, he said, is that it could stigmatize some people unfairly, because the tests aren't always accurate. Or it could backfire on the people it's supposed to help, making it more difficult for them to get insurance or renew a driver's license or even get people to take them seriously.

"You might say ... if you're going to tell me I have a disease that has no cure, I don't want to know about it right now," he said.

McCarten, though, sees no advantage in keeping people in the dark. "Here is a disease that will fundamentally alter your relationship with your family, your friends, your future," he said. "You deserve to know about it."

For John Wagner's family, the news was, in a sense, liberating. "This way, you know what you're dealing with," said his daughter Lisa. "We aren't treating this like it's a tragedy or a sad thing. We're treating it really practically."

The VA staff has offered tips on everything from financial planning to lining up help with transportation, housing and health care, if ever needed. "This is kind of cool, because now we have the attention of some people who really want to help us," Lisa Wagner said.

At the same time, Cofrancesco has told the family that the disease may progress slowly, and that John Wagner is functioning quite well in the meantime. Among other things, he still volunteers once a week at a hospital stroke unit. Just last week, he took another battery of memory tests that showed virtually no change since January.

"That's good," Cofrancesco told him. "That means that things are going OK."

John Wagner says he, too, has come to terms with his diagnosis. "You can't stop progress," he said. "Even though it's the wrong way."

Maura Lerner • 612-673-7384

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posted by Larry Scott
Founder and Editor
VA Watchdog dot Org

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