Doctors should screen for Alzheimer’s as soon as mild cognitive symptoms occur and encourage genetic testing for patients, according to the first new guidelines for the disease in almost three decades.
While early diagnosis won’t help patients fight off Alzheimer’s, it can help them prepare for when dementia worsens and decisions become difficult. Encouraging patients to enroll in trials that offer gene tests and brain scans may add knowledge about roots of the disease, according to guidelines published today in the journal Alzheimer’s and Dementia.
The new guidance reflects advances since 1984, including the discovery of 10 genes tied to Alzheimer’s, cerebrospinal fluid tests to help differentiate from other forms of dementia and better scanning techniques. They place Alzheimer’s along a degenerative spectrum with dementia as the final stage.
“We’ve been an advocate for early diagnosis for many years,” said William Thies, chief scientific officer of the Alzheimer’s Association, an advocacy group, in a conference call with reporters. “It allows people to anticipate what will happen and plan their lives to minimize the impact of what’s coming for them.”
The guidelines are the work of the Chicago-based Alzheimer’s Association, the National Institute on Aging and the National Institutes of Health. They solidify those proposed in July at the International Conference on Alzheimer’s disease.
Brain Scans, Spinal Fluid
Brain scans and spinal-fluid tests allow doctors to detect beta amyloid. Companies such as General Electric Co. (GE), based in Fairfield, Connecticut, and Indianapolis-based Eli Lilly & Co. (LLY) are developing dyes for brain scans that attach to amyloid protein, a signature marker of the disease.
Because biomarkers aren’t standardized, they aren’t ready for regular use in the doctor’s office, said Marilyn Albert, director of the division of cognitive neuroscience at Johns Hopkins University School of Medicine in Baltimore, and an author of disease guidelines on mild cognitive impairment. Getting more patients tested will improve research knowledge and expand databases on Alzheimer’s biomarkers, which may lead to better care and treatment.
Questions still remain about these biological measures, such as whether the accumulation of beta amyloid is the first stage of Alzheimer’s, Sperling said.
Important to Patients
Getting diagnosed early is important for getting on medication early, said Terry Christiansen, 77, who was diagnosed with Alzheimer’s in 2005. He is treated with Forest Laboratories Inc. (FRX)’s Namenda and Novartis AG’s Exelon patch. Christiansen, of Rochester, New York, participates in research and sits on his local Alzheimer’s Association board and is the first patient to serve, he said.
“Every year I get a blood test, an MRI, an oral evaluation and a lumbar puncture,” Christiansen said in a telephone interview. “What I like most is that I always get a report back on the progression of the disease.”
He and his wife, Patty, said they try to live normal lives. They’ve informed their family and have received support from Patty’s sister and husband-in-law and their children, they said. They’ve made burial arrangements, and Patty has begun taking over chores Terry used to handle, such as paying the bills.
Terry was diagnosed after he mentioned to his primary care physician that he was a bit more forgetful than usual, and his doctor referred him to the Alzheimer’s Association.
About 5.4 million Americans have Alzheimer’s disease, according to the Alzheimer’s Association. By 2050, that number is expected to increase to as many as 16 million.
By encouraging doctors and patients to seek a diagnosis earlier, rather than later, doctors also can begin to gather data to determine how often patients progress from a potential precursor state called mild cognitive impairment, Sperling said. It would also enable researchers to create better clinical trials in people that scientists know will likely progress to full-blown Alzheimer’s, she said.
In the meantime, the psychological testing done by most doctors for Alzheimer’s disease remains the same, said Guy McKhann, a professor of neurology at Johns Hopkins medical school.
“That hasn’t really changed much from a practical point of view,” McKhann said.
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