The University of Michigan School of Public Health professor Dr. Kenneth Langa, of the department of health management and policy weighs in on a current issue in the study and diagnosis of dementia.
Dementia and Alzheimer’s are an area of active research, as they continue to affect large proportions of the population with no available cure.
At the recent Alzheimer’s Association International Conference in Toronto, a new proposal was made to include persistent changes in personality and/or behavior as another clinical designation to identify individuals at risk for dementia. This designation is called “mild behavioral impairment” or M.B.I., and would be identified with a 34-question checklist administered to the patient.
Both studies and empirical evidence point to personality changes being a potential precursor to the more impairing changes in cognition and memory that are currently the first recognition of early stages of dementia.
However, not all dementia patients had personality changes before their diagnosis, and not all personality changes necessarily precede dementia. The disease is still shrouded in a lot of mystery. These unknowns make the potential benefits of identifying M.B.I. a matter of debate.
Dr. Langa says “There’s the potential benefit of early diagnosis, identifying people more likely to decline, but the flip side is over-diagnosis, labeling someone and getting people in the clinical cascade, where you start doing the test and people start doing more brain imaging and being at the doctor’s more and getting more concerned.”
As Dr. Langa points out, there is possible value in recognizing dementia early-on. Mood changes can be treated with medicines and therapy, and patients and family members can begin learning to help and cope with changes early-on. An M.B.I. diagnosis may also qualify some patients for clinical trials that would contribute to research towards treatments and cures.
On the “flip side” as Dr. Langa puts it, are the costs, both monetary and otherwise, of over-diagnosis. Because there is not a guarantee that a change in personality will definitely lead to dementia, people could spend large amounts of money on imaging and other tests that might prove unnecessary. Furthermore, because there is currently no cure for dementia and because M.B.I. doesn’t normally inhibit daily functioning, the emotional toll of finding out that you or a loved one might be on that road could outweigh any benefits of an early diagnosis. Why not live in blissful ignorance a bit longer if the outcome is the same either way?
There are costs and benefits to an M.B.I. diagnosis, and with so much still to learn about dementia, there is no clear answer as to which will tip the scales.