Two minutes to diagnose memory problems?
November 8th, 2010
04:28 PM ET

Two minutes to diagnose memory problems?

A screening test that takes just two minutes could detect as many as eight in ten cases of cognitive impairment, a condition that is often a precursor to Alzheimer’s, according to an article in the Archives of Internal Medicine. Current screening tests take a minimum of 10 to 15 minutes, and require the patient to write with pen and paper, an impossibility for many people who are hospitalized.

The new screening test is known as the “Sweet Sixteen,” because it involves 16 elements. There are eight questions on basic orientation, such as “where are you?” and “What day is it?” The person tested is also given three items to remember, asked to count a number sequence forwards and backwards and asked again about the three items.

According to the new paper, the Sweet Sixteen did just as well as other common tests – including the widely used MMSE, or Mini-Mental State Examination, in finding mild cognitive problems.

Dr. Tamara Fong, the lead author and an assistant professor of neurology at Harvard Medical School., as well as an assistant scientist at the Aging Brain Center at the Institute for Aging Research at Hebrew SeniorLife in Boston, says the Sweet Sixteen is only meant to be a first step, a trigger for further testing. However, she said its speed and ease of use – it requires only minimal training to administer – could make it widely attractive.

“One reason primary physicians don’t screen [for cognitive impairment] is because they don’t have time to do it,” says Fong. “If you only have 10 minutes for a visit, you’re not going to use a screening test that takes 10 or 15 minutes.”

Dr. Ron Petersen, Director of the Mayo Clinic Alzheimer’s Disease Research Center, said that while the test might prove useful, it should not be used to diagnose cognitive impairment.

“It’s important not to misuse it,” Petersen says. “But if it just means, ‘you’ve got to go and get checked by a physician,’ then, that’s a different story.”

Screening tests for cognitive impairment are becoming a hot-button issue, partly because of the aging population and partly because of a change in Medicare rules. The agency that oversees Medicare announced last week that starting in January, the program will pay for annual cognitive screening of all Medicare patients. The provision is part of the health care overhaul – The Patient Protection and Affordable Care Act – which President Obama signed into law last year.

soundoff (23 Responses)
  1. Javier Santos Fuente

    a quien me pueda ayudar,el domindo 07/11/2010 al mediodia en Argentina buenos Aires hicieron una nota al Dr Cruz Zamora, necesito informacion para su contacto, muchas gracias.

    November 8, 2010 at 17:14 | Report abuse | Reply
  2. BobDeMarco

    This is an important article. Here is my take. Let's say you decide to test someone that you are worried about. A spouse or parent. You find the results suspicious. Suspicious does not mean the person is suffering from Alzheimer's disease or dementia. But suspicious does warrant further investigation.

    You take this information to the personal care physician and request a referral to a neurologist or some other type of memory specialist.

    A good memory specialist will not only administer tests for dementia, they will also order an MRI if necessary and some serious blood test.

    There are many illnesses that can present as Alzheimer's disease. Two that come to mind are depression and hypothyroidism. These are treatable.

    There are a long list of illnesses and diseases that can present as Alzheimer's disease. A well experienced memory specialist knows this. There job is not only to diagnose dementia, but also to "rule out" other treatable causes of the memory problem.

    Don't hesitate. When you are worried, get a neurologist or memory specialist involved. Don't rely on the personal care physician alone. They are busy and they are not trained to conduct the extensive kinds of investigation that might be warranted.

    Bob DeMarco
    Alzheimer's Reading Room


    November 8, 2010 at 22:17 | Report abuse | Reply
    • Michelle

      How amusing – I went to a neurologist last spring because I'd been having memory problems, general cognitive problems, occasional blurred vision, confusion, sporadic agoraphobia episodes, along with severe migraines. The idiot tested my reflexes, checked to see if I had good nerve function in my toes, checked my balance, and told me I was fine, and to go home. She never did any tests related to memory. The kicker is that until this happened, I had a memory like a steel trap. MENSA qualified, biologist, high school valedictorian back in the day. I'm 30 years old... and I was told that everything was fine.

      People love to say that if you've got a problem, then go to a doctor. And so we do, and we shell out a small fortune to do it, and then we waste our time and money. Why go to a doctor who won't take you seriously?

      November 9, 2010 at 12:27 | Report abuse |
  3. Ron

    What worries me is that the doctors feel they don't have time to test if they are only seeing you for 10 to 15 minutes. How about you spend some time with your patients!!!

    November 9, 2010 at 10:41 | Report abuse | Reply
    • Jay

      Independent doctors do. The doctors that do not are the ones that are part of health organizations that essentially put quotas for scheduling. 15 minutes is not unheard of for a doctor visit. I heard someone break it down to 5's: 5 minutes to talk about symptoms, 5 minutes to examine, 5 minutes to diagnose, then out the door. It's a dysfunction of "healthcare," but it's the large provider organizations that are pushing for more patient visits per day, which means more billing, which means more income. It's truly unfortunate. How can a doctor really get to know you and your problems in 15 minutes?

      November 9, 2010 at 19:15 | Report abuse |
    • DONNA

      The medical system today pays doctors more, the more patients they see. Also, everyone demands Instant Gratification–"I want to see the doctor NOW!" Medical practices fit in people like that at the time expense of those of us who make regular appointments. Then there are the REAL emergencies which also have to be taken care of. I was a Registered Nurse for 22 years. Don't talk about things you know nothing about.

      May 23, 2012 at 19:38 | Report abuse |
  4. WomenOnGuard

    It is sad that Dr. visits only take, on the average, 10 minutes. But you also sit for an hour just to get in to see the Dr. Something is VERY unfair here. Drs. should take more time to know more about their patients.

    November 9, 2010 at 11:24 | Report abuse | Reply
  5. My name is, wait, what was that question about

    After asking you the last question, they will ask you how many questions they asked you: will it be 16 or 17?

    November 9, 2010 at 11:41 | Report abuse | Reply
  6. Spike5

    One of the responsibilities of the primary care physician is to refer patients to the appropriate specialist. He can't be an expert in all areas, and he won't have the time to do an in-depth examination for all possible ailments. But he should spend enough time with the patient to know when a referral is appropriate and which type of physician/specialist will be best suited to provide the proper diagnosis.

    Most physicians would be happy to spend an hour chatting with each patient if we were willing to compensate them accordingly. Medicare and most medical insurance policies have guidelines on how much they will pay. If you are willing to pay extra out of your own pocket for an extended visit, I'm sure the doctor would accommodate you. Otherwise, you are asking that all of us pay more for our medical insurance than we already do and that Medicare premiums rise even more.

    November 9, 2010 at 12:13 | Report abuse | Reply
  7. Ron

    I think it has more to do with doctors filling up 7 rooms and trying to keep them rotating out which in turn means more patients more money.

    November 9, 2010 at 13:13 | Report abuse | Reply
  8. Angie

    @Michelle – I hope you made another appointment with another doctor! My goodness!!!!

    November 9, 2010 at 13:59 | Report abuse | Reply
  9. Lola

    I had a follow-up appointment with a specialist recently, where she buzzed into the room, looked at me and said i was fine and could stop using the topical prescription. No follow-up questions. Nothing. I was charged the full $40 co-pay, and my insurance paid for a full medical appointment with a specialist. For about 90 seconds.

    November 9, 2010 at 14:57 | Report abuse | Reply
  10. Bad Betty

    @Michelle–I went thru the same lame testing (remember "cat, dog, tree" for 5 minutes), doofus neuro said nothing was wrong, but I knew my memory was different. Went elsewhere for testing and they found out I'd had a micro stroke, had lost 10 IQ points (still genius, thank you very much), and had ADD and dyslexia symptoms and short term memory loss. Complicating factor was sleep apnea–cause of the short term memory loss. CPAP fixed the short term and SOME of the other stuff came back as I healed, but I'm still dyslexic for numbers. And I used to perform memory tricks that involved reciting extremely long lists of numbers or items. When I told the first doctor about the IQ drop, he commented "well you're still higher than mine!" so he didn't think it was a problem.

    November 9, 2010 at 15:32 | Report abuse | Reply
  11. sad

    not sure doctors really know what they are doing. i'm scared to go to them.

    November 9, 2010 at 16:45 | Report abuse | Reply
    • DONNA

      And yet, when you are REALLY scared because something is really wrong, you will go to them,, and you will have no idea of your possible underlying medical conditions because you don't think doctors know what they are doing. Here is your solution: GO TO MEDICAL SCHOOL1111

      May 23, 2012 at 19:48 | Report abuse |
  12. Clarence

    I went to the doctor. I said "I can't remember from one second to another second".
    The doctor said "How long have you had this problem"?
    I said " What problem"?.

    November 10, 2010 at 15:06 | Report abuse | Reply
  13. Rose

    correct that there are many problems that at first glance may seem to be attributed to one brain disfunction and in actuality be another...or as the first responder stated, related to depression, trauma, low blood sugar, ADD, TIA'S and a host of other household words. I am acquainted either from personal experience or working with those who have the above mentioned maladies to know not to give a knee-jerk "diagnosis" for anything involving the brain directly and its function
    This article was just dealing with helping those of us who read it understand when to ask Dr. Sorry about all of your "bad Dr." experiences. Most are really caring and knowledgeable. i appreciate the ones who tell you up front they are not the best in that field and refer you to an expert in "whatever" so that you don't waste time and money !
    Brain is incredibly complex...and the ways folks deal with stresses of life just as complex.

    May 1, 2011 at 19:18 | Report abuse | Reply
    • DONNA

      Thank you, Rose.

      May 23, 2012 at 19:50 | Report abuse |
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    July 16, 2012 at 17:37 | Report abuse | Reply
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    There's no cure for dyslexia. It's a lifelong condition caused by inherited traits that affect how your brain works. However, most children with dyslexia can succeed in school with tutoring or a specialized education program. Emotional support also plays an important role. *;.-

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