26 Jan Reading Difficulties May Complicate Identification of Early Alzheimer’s Disease
MedicalResearch.com Interview with:
Dr. Brian K. Lebowitz, PhD ABPP-CN
DIRECTOR OF NEUROPSYCHOLOGY TRAINING
Clinical Assistant Professor, Neurology
Stony Brook University Medical Center
Medical Research: What is the background for this study? What are the main findings?
Dr. Lebowitz: As a lifespan neuropsychologist, my clinical work involves evaluating cognitive concerns in both children and adults. We know that children with learning disorders, such as dyslexia, often demonstrate difficulties on neuropsychological tests that are seemingly unrelated to reading. For example, children with dyslexia may have difficulty with auditory processing and short-term memory. We also know that, for many individuals, learning disorders remain present throughout the lifespan. Despite awareness of the relationship between reading disorder and other areas of cognitive weakness, many clinicians who work with older adults do not routinely ask about academic/neurodevelopmental history. Further, little research has assessed the potential impact of lifelong learning disorder on later life neuropsychological test performance. Our study attempted to assess whether or not a history of possible reading disorder increased the likelihood that an individual’s performance would fall at a level suggestive of possible Mild Cognitive Impairment MCI), a diagnosis associated with increased risk for Alzheimer’s disease. Individuals with MCI continue to function normally in everyday life but experience subjective memory problems and identified weaknesses on neuropsychological tests. Our study found a strong relationship between poor reading ability and low memory test scores on two tests commonly used to evaluate memory complaints in older adults. Depending on the test, individuals with a suspected reading disorder were two to three-and-one-half times more likely than their peers to score at a level indicative of Mild Cognitive Impairment.
Medical Research: What should clinicians and patients take away from your report?
Dr. Lebowitz: For clinicians, the take away message is that neurodevelopmental history may provide important information when evaluating older adults who are concerned about memory loss. A number of medical professionals (e.g., neurologists, geriatricians, psychiatrists) utilize screening instruments to identify possible memory loss. However, when a patient performs poorly on a screening instrument, it is important that clinicians consider the possibility that scores are low because of longstanding factors (e.g. learning disorder) and are not indicative of a neurodegenerative process such as Alzheimer’s disease.
If a person has difficulty with reading, or language, or attention at age eight, it is very likely those areas remain weak at age eighty. It is important to recognize that health care professionals often do not know a patient’s life story and it is to the patient’s benefit to review their cognitive history when discussing memory or other concerns. The information will help the physician interpret neuropsychological screening test results and to determine who may benefit from a more comprehensive neuropsychological examination.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Lebowitz: At this point, we do not know if poor neuropsychological test performance in older adults with learning difficulties represents a possible mis-diagnosis, or if having a learning difficulty represents a risk factor for neurodegenerative disease in later life. A longitudinal study that follows patients over time would be the best way to answer this question. Our research group is currently starting a project to look at the relationship between lifelong mathematics difficulties and cognitive test performance.
Medical Research: Is there anything else you would like to add?
Dr. Lebowitz: Patients are often under the impression that the experience of having reduced memory is a clear indication of Alzheimer’s disease. However, there are many reasons why an individual may experience thinking difficulties. There are many reversible and treatable causes of mild memory problems. Identifying the nature of subjective memory problems is the first step in addressing the problem. At present, the only objective method of measuring thinking skills is the neuropsychological examination. If an individual has concerns about changes in thinking skills, they are encouraged to speak with their doctor about a possible referral for an examination.
Brian K. Lebowitz, Cheryl Weinstein, Alexa Beiser, Sudha Seshadri, Philip A. Wolf, Sandford Auerbach, Rhoda Au. Lifelong Reading Disorder and Mild Cognitive Impairment: Implications for Diagnosis. Journal of Alzheimer’s Disease, 2015; 50 (1): 41 DOI: 10.3233/JAD-150543
Dr. Brian K. Lebowitz (2016). Childhood Reading Difficulties Can Presage Cognitive Impairment in Adults