CATES: Predicting cognitive impairment

By Carol A. Cates, MSN, MBA, RN

Chief Nursing Officer

Odessa Regional Medical Center

For a while now, I have made jokes about being part of the “sandwich generation.” That age where you are raising your kids and your parents. But the reality is, I have been lucky.

My kids are grown with little more than the usual teenage angst. My mom passed away at a young age, but my dad is now in his early 80’s with few health concerns and no sign of cognitive issues. Unfortunately, I have watched friends and relatives in the sandwich generation years who have not been so lucky. Some because of kid issues, and others with their parents who have some form of dementia.

One of the things that strikes me so often when I speak to the children of people who suffer from dementia, it’s not just the stress of a parent struggling with that condition, its also the worry of “is this going to be me when I get older,” that makes being a child of a person with dementia so very hard.

Back when I taught nursing, I used to remind students that there is a reason we call what we do practice instead of perfect. We call it that because every person is different, every situation is different. No one can say when this happens that is the result for every single person, every single time. People and situations in health care are just too different. That is why health care providers always look at risk factors when it comes to predicting health.

For example, if your dad and your granddad died of heart attacks at 40 doesn’t mean you are going to die at 40 from a heart attack too. But it does mean you are at a much higher risk than someone who has no family history of heart disease. And understanding that risk can help you avoid if possible, and if you can’t avoid, recognize, and start treating it early where the outcomes tend to be much more positive.

Dementia in its many forms, including Alzheimer’s disease, is like heart disease where a family history does put you at higher risk. There is genetic testing now for Alzheimer’s disease. But most physicians do not recommend people run out and get genetic testing for Alzheimer’s because while we know there are genetic markers, we don’t know how they work and how they interact with each other. Because we don’t know, the genetic testing doesn’t really give us more information than knowing the family history. It doesn’t help with the worry of “is this going to be me….”

There is some light forming at that end of that “is this going to be me” tunnel. Something that can better predict risk for developing cognitive impairment like the many forms of dementia and do it long before symptoms appear. That way a person at risk can avoid if possible and recognize and treat early when its unavoidable. In a study recently published in the journal of the American Academy of Neurology, the researchers developed at test, called the SOMI test, that was able to accurately determine risk of cognitive decline years before symptoms appeared.

In the study, researchers followed 969 people with an average age of 69 for 10 years. All the participants had no thinking or memory problems at the beginning of the study. Based on test results participants were divided into 5 groups. Stage zero had no memory issues, stages one and two had difficulty retrieving memory which showed high risk of dementia within 5-8 years, stages three and four showed a high risk of dementia within 1-3 years. Even when they statistically removed other risk factors for dementia, the SOMI test was consistently accurate in predicting cognitive impairment risk within those time windows.

SOMI testing does need more research. 969 people is not a big enough number when it comes to validating a testing method and the researchers admit they need to look at more diverse populations than their study participants included. But what these researchers have done seems very promising in better predicting the risk of dementia. And what is exciting to me is it does it in a way where people have time to take action to lessen their risk, and to plan for all the “what if’s” that life can throw as people deal with a chronic illness like dementia. Hopefully, that research will be done soon, and it will continue to show great results. That way we can all start asking our primary health care provider to include SOMI testing in our routine care and start mitigating any risk for cognitive impairment.