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Correspondence: Address correspondence to Frederick J. Kier, PhD, VA Pittsburgh Healthcare System, Highland Drive Division (116 A-H), 7180 Highland Drive, Pittsburgh, PA 15206. E-mail: frederick.kier{at}med.va.gov
The Early Alert Alzheimer's Home Screening Test (AHST) is a variant of the Smell Identification Test (SIT) and the Cross-Cultural Smell Identification Test (CC-SIT), and recently became available for purchase by the general public. The validity and the practical utility of routine screening for individuals with asymptomatic cognitive impairment has not been established. There are considerable specific methodological concerns regarding the use of the AHST including the association of olfactory impairment with (a) age in the absence of cognitive impairment, (b) numerous acute and/or chronic medical conditions, and (c) lifestyle habits and social and/or demographic variables. General public misunderstanding of the difference between a screening and a diagnostic test, primary care physicians' frequent confusion about follow-up mechanisms for newly diagnosed patients with dementia, the possible lack of perceived counseling options for those self-diagnosed, and abuse of test findings create distinct possibilities for misuse of this test. The marketing of the AHST and its general use without appropriate public health educational safeguards is inappropriate and may be unethical.
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