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Rite Aid memory test spurs needless worries, doctors say

Memory tests given at Rite Aid Corp. drug stores as an early warning for Alzheimer’s are drawing fire from doctors who say they don’t work well and may cause unwarranted fear among people who don’t have the disease.

The drugstore chain is making the tests available this month at more than 4,000 sites in partnership with the Alzheimer’s Foundation of America, a nonprofit advocacy group. The 5- to 10-minute test of oral and written questions screens for early memory loss, including types tied to Alzheimer’s and dementia, according to the foundation.

The screenings raise disease awareness and may spur a consumer to see a doctor early, said Carol Steinberg, the foundation president. Some physicians, though, argue the tests can be inaccurate and that people who do poorly may spend time and money worrying about a disease they don’t have. They urge the tests be given in a medical setting, so the results are assessed by a professional trained in memory loss detection.

“Teaching someone how to perform a cognitive assessment is not a trivial manner,” said David Knopman, a professor of neurology at the Mayo Clinic in Minnesota, in a telephone interview. “It takes some training and background in knowing about neurology.”

Knopman is a member of the scientific advisory board of the Chicago-based Alzheimer’s Association, which doesn’t support the tests.

The New York-based Alzheimer’s Foundation, founded in 2002 and led by former New York state senator Charles Fuschillo, is an umbrella of 1,700 nonprofit, social service and health care groups nationwide that help support patient’s families and caregivers. The Alzheimer’s Association, founded in 1980, is led by former American Cancer Society vice president Harry Johns and bills itself as the largest nonprofit funder of Alzheimer’s research.

Alzheimer’s, the most diagnosed form of dementia, affects about 5 million people in the U.S. and the number is estimated to triple by 2050. There is no cure for the brain-ravaging disease that causes memory loss and confusion. Alzheimer’s may be the country’s third-leading killer, causing as many as a half-million deaths annually, researchers reported in March.

The tests at Rite Aid, which were first offered last Wednesday at no cost, are part of the chain’s “wellness65+Wednesday” events in June that encourage the elderly to manage their health, according to the company and the Alzheimer’s Foundation. Rite Aid has additional screenings this month at select stores.

“We’ll continue to explore ways to bring AFA screenings and resources to our customers and the communities we serve,” said Ashley Flower, a spokeswoman for Camp Hill, Pa.-based Rite Aid, the third-largest drugstore chain in the United States. She said the pharmacists have been instructed on how to administer the screening. The AFA provided the paper tests, called a Mini-Cog.

The test works by asking patients to remember three unrelated words, drawing the numbers of a clock into an empty circle, drawing hands to a specific time on that clock, then asking the patient to recall the three words again. The test may show memory issues, but there is limited evidence supporting its use as a diagnostic tool for dementia, researchers said in an October study in the Annals of Internal Medicine.

While the drugstore chain’s partnership with the foundation may raise awareness about dementia, “there are huge problems with large scale screening at this point,” said Arthur Caplan, director of the division of medical ethics at the NYU Langone Medical Center. “This diagnosis is so feared, so terrifying to people that doing a well-intended but not extremely accurate or well-counseled program can lead to a lot of trouble.”

The U.S. Preventative Services Task Force has said since 1996 that there’s not enough evidence to recommend for or against routine screenings for dementia in older adults.

People can fail the tests for many reasons, including sleep deprivation or depression. In a setting as busy as a pharmacy, it can be hard to assess accurate results, Knopman said.

“Generally the people at pharmacies or within a drug store do not have the medical expertise whether to judge whether it’s a valid test or what the results of exams mean,” said Dean Hartley, the director of science initiatives at the Alzheimer’s Association. “They’re not trained in terms of memory issues or dementia.”

Tracey Meade, a professor at South University School of Pharmacy based in Savannah, Ga., said the use of screening tools is taught in pharmacy schools, and students learn about cranial nerves, disease states and treatments available for neurological diseases.

“Screening tools are very useful, especially to retail pharmacists, and students probably have a higher degree of knowledge than other health-care professionals realize,” she said. Because pharmacists are easier to reach and available at off hours, she said it’s important for patients to be able to connect to them and learn about how to improve their health.

Meade worked at Rite Aid for six years until about a month ago and said she hasn’t administered one of the Mini-Cog tests.

Steinberg, of the Alzheimer’s Foundation, said pharmacists are trusted health-care professionals who communicate with people with illnesses all the time, similar to nurses or social workers. The screening results are not a diagnosis, and the pharmacist would prompt a patient to follow up with a doctor. There are also educational materials on brain health available for customers.

The “great advantage,” to this event is that it raises awareness about getting tested for cognitive function early, which should be just as routine as blood pressure checks, said Marsel Mesulam, director of the cognitive neurology and Alzheimer’s disease center at the Chicago-based Feinberg School of Medicine at Northwestern University.

“It’s like if you feel that you have a problem with diabetes or blood pressure, I don’t think your next door pharmacy is a place to handle this problem in a systematic way, he said. ”Anyone who feels like it, should go, as long as it’s understood that these tests require a lot of interpretation.”

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