What's the fastest, most efficient type of medical test for early signs of Alzheimer's disease, depression, or diabetes risk? You can be forgiven for assuming it's a brain scan, a blood test, or a genetic screen. But in all three cases, the best tool may actually be the humble pencil. Sometimes the most effective way to diagnose a condition or assess a patient's risk is to have him fill out a standardized questionnaire, either on paper or on a computer. Yes, the tests look simple. But that's the beauty of them—they're designed that way, for ease of use, and to allow doctors to quickly get crucial information that patients might not otherwise know to volunteer. "Tools like this get used all sorts of ways," says Larry Culpepper, chair of family medicine at Boston University School of Medicine. "They don't replace talking to the patient to confirm what's on the paper, or find out more. There are other things I have to do to confirm the diagnosis. But these tests sure speed that up." Bonus: unlike their costly high-tech counterparts, they're practically free to administer. Here's a look at some of the best:
The SAGE test for Alzheimer's
About those brain, blood, and genetic scans for Alzheimer's: all of them exist or are in development. But if your doctor is concerned about the disease, he isn't likely to employ one as a first line of testing. Instead, he'll probably try to assess whether you have mild cognitive impairment—the "where did I put my keys" kind of memory loss that may be an early sign of impending dementia—by having you answer a few questions. This can be done on the computer, as with the CANS-MCI, a series of tasks that were subjected to six years of clinical research before docs introduced them widely into practice. Since 2001, several studies funded by the National Institute on Aging have found that the CANS-MCI is a reliable and valid way of picking up on the very first signs of Alzheimer's, which is key, given that drugs for the disease work best when they're given early.
There's also a new test called the Self-Administered Geocognitive Examination (SAGE), which is done entirely on paper. The questions sound almost laughably simple, like the sort of things you might ask a second grader: "How many nickels are in 60 cents?" "Draw a large face of a clock and place in the numbers." Remarkably, just by having patients answer a few pages of questions like this, doctors can identify 80 percent of people with mild cognitive impairment. (There aren't a lot of false positives, either: 95 percent of mentally healthy people have "normal" scores on the test.) Douglas Scharre, the Ohio State University Medical Center neurologist who developed the test, notes that it has a big benefit for busy doctors as well as for patients: it doesn't have to be taken under supervision, so patients can complete it in the waiting room.
The M3 for mental illness
Back in the 1990s, doctors came up with an easy way to recognize depression: the PHQ-9, a list of nine questions about daily life (Have you had trouble sleeping? Are you "moving or speaking so slowly that other people could have noticed?") over a two-week period. The questionnaire was "a fabulous step forward in terms of getting depression recognized and treated," says Culpepper, the Boston family practitioner. "But a number of us felt it was leaving doctors in the dark in terms of other conditions that the patients might have." The PHQ-9 screens only for depression; it does not discriminate between that illness and others that may share symptoms, such as bipolar disorder. "If we're treating those patients as routine depression patients, there are obvious risks," says Culpepper (for instance, some antidepressants can make bipolar disorder worse).
That concern drove Culpepper to help develop the M3, a single-page checklist that takes less than 10 minutes to complete and that flags depression, bipolar disorder, posttraumatic stress disorder, and anxiety disorders. "There are other things we have to do to confirm the diagnosis," says Culpepper, "but this sure speeds it up." The idea is to take the test frequently, monitoring the ups and downs of your score and thus your mental health. It's available online, so you can e-mail the results to your doctor. Want to take it on your smart phone? Pretty soon, says Culpepper, there'll be an app for that.
The prediction score for diabetes
If you've ever been tested the traditional way for diabetes risk—with a 14-hour fast, followed by a blood draw, a cup of a disgustingly sweet drink, a two-hour wait, and another blood draw—you know how unpleasant it can be. Even doctors admit that the oral glucose-tolerance test is"relatively costly, inconvenient, and labor-intensive, and its reliability has been questioned."The good news is, all that effort may not be necessary. Last year researchers published a study suggesting that a few bits of basic information could identify adults at high risk for diabetes (no blood draw necessary). The researchers measured waist circumference, blood pressure, height, and pulse; they also accounted for age, race (diabetes is more common in some minorities), a family history of the disease, and a history of smoking. This information alone was enough to give them a reliable algorithm for predicting a person's risk of developing diabetes in the next 10 years. The algorithm does have some limitations; for instance, it hasn't yet been tested in people under 45. But someday it could replace traditional diabetes risk assessment for everyone but those at the highest risk, and that's great news for the rest of us.