Should You Use an At-Home Test for Alzheimer’s Disease?

It’s scary to consider that you, or a loved one, may have Alzheimer’s disease, the most common type of dementia. Alzheimer’s disease involves the parts of the brain that controls thought, memory, and language. As you may have observed in others, Alzheimer’s can gradually make it hard to carry out even the simplest of daily activities. If you think that you or a loved one might have Alzheimer’s disease, how can you get a diagnosis? Should you go to a doctor for an evaluation? Or can you use an at-home test for Alzheimer’s?

Before I discuss the pros and cons of using an at-home test for Alzheimer’s disease, let’s start with an overview of Alzheimer’s and other forms of dementia.

Please note that this post is written for people who are worried about their own cognitive decline. However, the information is also pertinent for those concerned about a loved one’s cognitive decline.

What is Alzheimer’s disease?

Importantly, Alzheimer’s disease is not a normal part of aging. Instead, it occurs when the brain undergoes complex changes that lead to the loss of brain cells and their connections. Interestingly, these changes begin years before any symptoms appear.

Sadly, Alzheimer’s disease slowly destroys memory and thinking skills. Alzheimer’s starts with mild symptoms, but eventually, those with Alzheimer’s lose the ability to carry out even the simplest tasks. Moreover, some people with Alzheimer’s experience personality changes along with difficulties controlling their emotions and other behaviors.

How common is Alzheimer’s disease?

Experts estimate that over 6 million Americans, many of them age 65 and older, have Alzheimer’s disease.

What causes Alzheimer’s disease?

Alzheimer’s dementia is usually associated with abnormal buildups of proteins in the brain – known as amyloid plaques and tau tangles – along with a loss of connection among nerve cells. Interestingly, doctors can see these changes in patient’s brains using a PET scan.

Unfortunately, experts do not fully understand what causes the buildups of proteins and a loss of connection among nerve cells. However, experts believe the causes of Alzheimer’s disease probably include a combination of:

• Age-related changes in the brain – including shrinking, inflammation, blood vessel damage, and a breakdown of energy within brain cells, which might harm neurons and affect other brain cells.
• Genetic changes or differences – which may be passed down by a family member. Both types of Alzheimer’s – the very rare early-onset type occurring between age 30 and mid-60s, and the most common late-onset type occurring after a person’s mid-60s – may be related to a person’s genes. Interestingly, many people with Down syndrome will develop Alzheimer’s as they age and may start to show symptoms in their 40s.
• Health, environmental, and lifestyle factors may play a role, possibly including exposure to pollutants, heart disease, stroke, high blood pressure, diabetes, and obesity.

What are the signs and symptoms of Alzheimer’s disease?

Unsurprisingly, memory problems often appear as one of the first signs of Alzheimer’s. Symptoms can include problems with:

• Word-finding – having more trouble coming up with words than other people the same age.
• Vision and spatial issues – like a lack of awareness of the space around them.
• Impaired reasoning or judgment, which can impact decisions.

Additionally, people with Alzheimer’s may experience changes in behavior, including the following:

• Taking longer to complete normal daily tasks.
• Repeating questions.
• Difficulty handling money and paying bills.
• Wandering and getting lost.
• Losing things or putting items in odd places.
• Changes in mood and personality.
• Increased anxiety and/or aggression.

Cognitive issues can have other causes.

It’s important to understand that a variety of other issues can cause cognitive symptoms. For instance, mini-strokes, sleep apnea, thyroid problems, vitamin B12 deficiency, and medication interactions can each lead to cognitive issues.

What’s the difference between dementia and Alzheimer’s disease?

Importantly, dementia is an “umbrella term used to describe a range of neurological conditions affecting the brain that get worse over time”. Dementia symptoms include the decline in cognitive abilities and the changes in behavior experienced by people with Alzheimer’s disease.

Understandably, many people use the terms “Alzheimer’s disease” and “dementia” interchangeably.  However, Alzheimer’s disease is just one type of dementia, with other diseases and conditions also causing dementia (see below). But Alzheimer’s disease is the most common cause of dementia in older adults,

What are the other types of dementia?

As mentioned above, Alzheimer’s disease is not the only type of dementia. Other types of dementia include:

• Frontotemporal dementia (FTD) is rare and tends to occur in people younger than 60. FTD is caused by a group of disorders that gradually damage the brain’s frontal and temporal lobes, causing changes in thinking and behaviors. Symptoms can include unusual behaviors, emotional problems, trouble communicating, challenges with work, and difficulty with walking. These changes include abnormal amounts or forms of the proteins tau and TDP-43, and the loss of nerve cells.
• Lewy body dementia (LBD) is a brain disorders that can lead to problems with thinking, movement, behavior, and mood. Patients with LBD commonly experience visual hallucinations (seeing things that are not there) which tend to occur in the early stages. The brains of people with LBD contain abnormal deposits of a protein called alpha-synuclein, also called Lewy bodies.
• Vascular dementia occurs when blood flow to the brain is disrupted, leading to problems with memory, thinking, and behavior.  in people who have vascular changes in the brain, such as a stroke or injury to small vessels carrying blood to the brain. In MRI scans, the brains of people with vascular dementia often show evidence of prior strokes, thickening blood vessel walls, and thinning white matter — the brain’s connecting “wires” that relay messages between regions. Vascular dementia is the second most common dementia diagnosis.

Interestingly, patients may receive a diagnosis of “mixed dementia” related to a mixture of changes in the brain. For instance, a person might have evidence of changes normally associated with both Alzheimer’s and vascular dementia.

How do doctors diagnose Alzheimer’s disease?

If you and your doctor are worried about a decline in your cognitive abilities, your doctor will likely use several methods and tools to determine if you have Alzheimer’s disease, including the following:

• Ask you questions about your overall health, use of prescription and over-the-counter medicines, diet, past medical problems, ability to carry out daily activities, and changes in behavior and personality. The doctor will also ask your family members these questions since cognitive issues can make it hard to accurately answer these questions.
• Conduct tests of memory, problem solving, attention, counting, and language.
• Order blood, urine, and other standard medical tests to determine if there are other possible causes of your cognitive issues.
• Administer a psychiatric evaluation to determine if depression or another mental health condition is causing or contributing to your symptoms.
• Order a spinal tap to collect cerebrospinal fluid (CSF) to measure the levels of proteins associated with Alzheimer’s and related dementias.
• Perform brain scans, such as computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET), to support an Alzheimer’s diagnosis. These imaging tests can rule out other possible causes for symptoms.

Early detection of Alzheimer’s can help you and your family.

Getting an early, accurate diagnosis can benefit you in many ways. Firstly, most medicines work best for people who are in the early or middle stages of Alzheimer’s.

Additionally, getting an early diagnosis can help you and your family:

• Make plans for the future.
• Consider financial and legal matters.
• Address potential safety issues.
• Learn about living arrangements for the future, as the condition worsens.
• Develop support networks.

Furthermore, getting an early diagnosis provides you with more opportunities to participate in clinical trials or other research studies evaluating possible new treatments for Alzheimer’s.

Should you use an at-home test for Alzheimer’s disease?

Certainly, the current diagnostic methods require specialized clinics and trained staff, which can be difficult for some people to access. Additionally, the current evaluation regimen is expensive, time consuming, and invasive.

Interestingly, Quest Diagnostics aims to improve the diagnostic process with their new product, the AD-Detect Test for Alzheimer’s Disease. AD-Detect is the first blood test for consumers that measures a biomarker linked to Alzheimer’s disease.

Simply put, the test measures amyloid ratios in the blood to determine if there are amyloid deposits in the brain – a hallmark of Alzheimer’s disease.

Importantly, this test is marketed as a starting point for evaluating the risk of Alzheimer’s – it will NOT provide a definitive diagnosis.

However, an amyloid ratios test could indicate a risk for Alzheimer’s years before you develop symptoms. And the test could help you and your doctor develop strategies which may include interventions and a plan for managing the condition.

Experts worry about Quest’s at-home test for Alzheimer’s.

On a positive note, researchers currently use blood biomarker tests in Alzheimer’s drug trials to verify the impact of the drug being studied and to screen potential participants.

Furthermore, in some studies, these blood tests provide similar information to “gold standard” testing (brain imaging scans and cerebrospinal fluid analysis).

On the other hand, Alzheimer’s researchers and clinicians worry that Quest’s at-home test for Alzheimer’s may not be backed by sound scientific research. In fact, Quest has not published any peer-reviewed studies documenting the test’s validity, although several studies have been submitted to medical journals and may be published in the coming months.

Furthermore, Quest released preliminary data at the 2022 Alzheimer’s Association International Conference that suggests a relatively high chance of false-positive results, causing concern among experts and anxiety for patients.

Additionally, experts worry that older adults may struggle to understand the significance of their results. For instance, a positive tests result showing abnormal levels of amyloid does not mean you will definitely develop Alzheimer’s. Since amyloid accumulates slowly in the brain over decades, usually starting in middle age, it is commonly found among older people, not all of whom will develop Alzheimer’s.

In other words, even if you have positive results, this alone will not tell you if you will get Alzheimer’s or when you might develop symptoms.

But the AD-Detect at-home test for Alzheimer’s may soon become a commonly used tool. The chief science officer of the Alzheimer’s Association states that although “further standardization and validation are needed, blood tests may soon be an important piece of the diagnostic workup in everyday practice for detecting and monitoring treatment of Alzheimer’s disease.”

The potential concerns of receiving a diagnosis before symptoms appear.

The National Institute on Aging and the Alzheimer’s Association recently proposed a new definition of Alzheimer’s disease for use in clinical practice. Currently, to diagnose a patient with Alzheimer’s, a doctor must see evidence of changes in the brain, as well as cognitive symptoms, and difficulty performing daily tasks.

However, the newly proposed definition only requires biological evidence of changes in the brain, including amyloid accumulation. Therefore, a positive result on the AD-Detect test could lead to a diagnosis of Alzheimer’s even if you don’t have symptoms.

Importantly, you could face employment discrimination or denials of life, disability, or long-term care insurance. Yet, you may never develop Alzheimer’s!

Has the FDA approved AD-Detect?

As of today, AD-Detect has not been cleared or approved by the US Food and Drug Administration (FDA). However, AD-Detect does not currently require FDA approval because it is considered a “laboratory developed tests” or LDTs – tests that are designed, manufactured and used in a single laboratory. Currently, the FDA does not regulate LDTs, as long as the tests come from laboratories that meet certain compliance criteria.

However, as LDTs become increasingly complex and more common, the regulatory status may soon change to require FDA approval.

Thinking of using an AD-Detect at-home test for Alzheimer’s?

Consider why you want to take the test.

Don’t take this test before thinking it through. As suggested by Dr. Cullum, a neuropsychologist and professor at University of Texas Southwestern Medical Center, ask yourself these questions:

• Why do I want to know this?
• What will I do with the information?
• How will I react?
• What would I change in my future?

Consider the pros and cons of AD-Detect tests.

Pros:

• AD-Direct may provide an early indication of risk for Alzheimer’s years before you develop symptoms, which can help you and your family.
• The test may lead you to seek further testing and possible treatment from an expert.
• The test is easier for patients to tolerate than brain scans or lumbar punctures.

Cons:

• There is currently no scientific data proving its accuracy, leading experts to discourage its use. Note this could change in the future with the publication of scientific studies.
• The high rate of false positive results could cause you unnecessary anxiety.
• The test is expensive and is not covered by insurance.

Talk to your doctor before buying an at-home test for Alzheimer’s.

Before you order a test, discuss the pros and cons of the test with your doctor. And make sure you discuss the possible consequences of a positive result.

Importantly, follow up with your doctor to discuss your results. Interestingly, many people with amyloid deposits don’t develop cognitive impairment, so discussing your results with a doctor is critical.

However, if you don’t have a doctor, Quest has a network of independent doctors with whom you can discuss your results (for a small, additional fee). Additionally, Quest states one of their network doctors proactively reaches out to anyone with results that suggest a risk of Alzheimer’s disease.

Where can you by an AD-Detect test?

• Suspect they may have Alzheimer disease.
• Have a family history of Alzheimer’s.
• Have a genetic predisposition to Alzheimer disease.
• Had previous brain trauma or head injury.
• Experience memory loss or early cognitive decline (“trouble remembering, concentrating, making decisions, etc.”).
• Consume alcohol in excessive amounts.

Importantly, it is hard to judge your own cognition, which can make it hard to determine if you need to be tested for Alzheimer’s disease.

How do doctors treat Alzheimer’s disease?

Unfortunately, there is currently no cure for Alzheimer’s. However, the FDA has approved several medicines that can help manage some symptoms of the disease. For instance, in July 2023, the FDA approved Leqembi, an anti-amyloid therapy that slightly slows cognitive decline in people with mild cognitive impairment and early-stage Alzheimer’s.

In addition to medications, your doctor may suggest coping strategies to help you manage behavioral symptoms.

Fortunately, researchers are exploring other drug therapies and nondrug interventions to delay or prevent the disease, and to treat symptoms.

Learn more about Alzheimer’s treatments on the National Institute on Aging website.

You Can Reduce Your Risk of Alzheimer’s!