Touch-tone system tests for early signs of dementia

CHICAGO -- If automated touch-tone phone systems drive you bonkers, imagine one designed to see if you really are.

That's generally the idea behind an experimental program set up to screen older callers for early signs of dementia and Alzheimer's disease, and supporters say it's not as crazy as it sounds.

In a study of 155 patients, the touch-tone system identified warning signs in 80 percent of patients who'd also been diagnosed with mental impairments by their doctors. It also gave passing grades to 80 percent of patients diagnosed as normal by their doctors.

Results appear in today's Archives of Internal Medicine.

The program is designed as a sort of toll-free touch-tone triage center for people in the community who may wonder if their forgetfulness is a sign of something serious. While the creators acknowledge that many people disdain automated phone systems, they also say some may actually prefer the system's anonymity.

"This whole technology shouldn't be aimed at trying to replace clinicians, but hopefully as a way to facilitate clinicians and empower patients," said psychologist James Mundt, a research scientist at Healthcare Technology Systems, Inc. in Madison, Wis. and lead author of the study.

"This might guide them more quickly to seek help or reassure them that they're doing very well," said Dr. John Greist, a psychiatrist and the company's chief executive officer.

Previously screened

The company designed the system and participated in the research, which was funded by the National Institute on Aging.

Participants were patients aged 56 to 93 at clinics in Madison and at the University of Iowa who'd been previously screened by their doctors.

They were given recorded instructions such as "Spell 'fun' on the touch-tone pad," and "Press '1' if the following sentence makes sense: 'We wanted to cut down the tree in the yard so we went to the garage to get a hammer,'" Mundt said.

Bill Thies, vice president for medical and scientific affairs for the Alzheimer's Association, said a drawback is that "people who are significantly demented are not going to be able to get through the test."

In fact, 16 mentally impaired patients weren't able to finish the test. Mundt acknowledged the limitation but said the system worked well for people who were mildly impaired.

Thies called the research "a particularly interesting area" that should be further investigated.

Many suspect there are significant numbers of people with early symptoms of Alzheimer's who could be getting help, and an automated system might be a good, low-cost way to track them down, Thies said.

Dr. David Bennett, director of the Alzheimer's Disease Center at Rush-Presbyterian-St. Luke's Medical Center in Chicago, called the concept intriguing but said there's no guarantee that a widespread system like the one studied would attract more than just "the worried well."

The system is similar to one used a few years ago on National Depression Screening Day to urge depressed people to seek treatment.

"We got 100,000 calls in the first day," said Lee Baer, a Harvard Medical School psychologist involved in the project.