New Alzheimer’s Guidelines

                    

In 1906, Dr. Alois Alzheimer cared for a woman whose symptoms included memory loss, language problems, and unpredictable behavior. What was this unusual mental illness?  How should it be treated?  Could it be cured?  It wasn’t until after she died that Dr Alzheimer discovered answers to some of his questions, but many questions remained unanswered.  He examined her brain and found many abnormal clumps (now called amyloid plaques) and tangled bundles of fibers (now called neurofibrillary tangles).

Plaques and tangles in the brain are two of the main features of Alzheimer’s disease. The third is the loss of connections between nerve cells (neurons) in the brain.  Until relatively recently, Alzheimer’s disease could not be definitively diagnosed until after the afflicted individual had died. The care and treatment were based on the symptoms the patient displayed.

Alzheimer’s disease is an irreversible, progressive brain disease that slowly destroys memory and thinking skills, and eventually even the ability to carry out the simplest tasks, like chewing and swallowing.  In most people with Alzheimer’s, symptoms first appear after age 60. 

Scientists still do not fully understand what causes Alzheimer’s disease.  It is felt to have genetic, environmental and lifestyle factors.  Now, for the first time in nearly three decades, new guidelines for Alzheimer’s disease have been released by the American Alzheimer’s Association and the US National Institute of Aging.  These guidelines tell us that:

• Alzheimer’s disease is being recognized as a continuum of stages, not a single incident.  It occurs gradually over many years.  Alzheimer’s itself has clear symptoms of cognitive and functional impairments that are beyond memory loss such as visual, spatial and judgment problems and inability to care for one’s own needs.
• Mild cognitive impairment (MCI) with mild symptoms of modest impairments (like memory issues) may be the harbinger of Alzheimer’s disease, but progression to Alzheimer’s disease is not inevitable.  People with this condition have more memory problems than normal for people their age but not everyone with MCI progresses to Alzheimer’s.
• A newly classified preclinical stage is characterized by no symptoms but definitive brain changes that occur about 10 years before dementia sets in. Biomarkers (indicators of certain proteins) in blood and spinal fluid can be identified at this stage.  These amyloid proteins are used to diagnosis the disease and assess its progression.  The tests and data are still in the research phase; there is still much work to be done before this screening will become a regular part of an exam but it will become invaluable to the future diagnosis and treatment of the disease.

These new guideline changes are unlikely to change current assessments being done in physician’s offices.  The diagnosis will still be made by the health care professional with the assistance of someone who knows the individual well and often by the individual themselves.  In the near future when research is completed, the use of these biomarkers will establish the certainty of the diagnosis rather that having to rely on clinical symptoms only.  The ability to diagnosis an individual at a preclinical stage will allow for much earlier treatment, prevention efforts, and the great potential for improved results.  Current findings suggest that medications to slow the progression of Alzheimer’s disease are started too late to be effective.  Consider the improvement seen in the prevention of heart attacks with use of statin drugs for those individuals with elevated cholesterol; for many the use of statin drugs and lifestyle changes successfully prevent serious heart disease.  The same may one day be said regarding Alzheimer’s disease.

Estimates vary, but experts indicate that as many as 5.1 million Americans may have Alzheimer’s disease.  The diagnosis of MCI will greatly increase these numbers.  Already there are studies are suggesting that up to 10 million baby boomers will suffer some form of dementia.  These numbers are overwhelming but we must not give into despair.  The push for more research, more and better screening tools and more effective treatment options is critical.  Education, preparation and support of the already 15 million Americans caring for someone with Alzheimer’s or dementia is essential.  Without these family caregivers, the quality of life of an Alzheimer’s patient would be impossible.