Alzheimer's, Dementia & Mental Health
New Guidelines for Alzheimer’s Diagnosis Starts with
Pre-Alzheimer’s, Marks Advances
Some older people have abnormal levels of amyloid
plaques, yet never show signs of dementia… amyloid deposits begin early
in the disease process but tangle formation, loss of neurons occur
later; new report for boomers, see below news story
|
Alzheimer's Association has also
released a new book for baby boomers about AD, read more below
news story. |
April 19, 2011 - For the first
time in 27 years, clinical diagnostic criteria for Alzheimer’s disease
dementia have been revised, and research guidelines for earlier stages
of the disease have been characterized to reflect a deeper understanding
of the disorder. The guidelines released today cover the disease from
pre-Alzheimer’s and across its many gradually changes over many years.
The new standards, known as
the National Institute on Aging/Alzheimer’s Association Diagnostic
Guidelines for Alzheimer’s Disease, outline some new approaches for
clinicians and provide scientists with more advanced guidelines for
moving forward with research on diagnosis and treatments.
“They mark a major change in
how experts think about and study Alzheimer’s disease,” according to the
joint news release. Development of the new guidelines was led by the
National Institutes of Health and the Alzheimer’s Association.
The original criteria were the
first to address the disease and described only later stages, when
symptoms of dementia are already evident. The updated guidelines
announced today cover the full spectrum of the disease as it changes
over years.
They describe the earliest
preclinical stages of the disease, mild cognitive impairment, and
dementia due to Alzheimer’s pathology. Importantly, the guidelines now
address the use of imaging and biomarkers in blood and spinal fluid that
may help determine whether changes in the brain and those in body fluids
are due to Alzheimer’s disease.
Biomarkers are increasingly
employed in the research setting to detect onset of the disease and to
track progression, but cannot yet be used routinely in clinical
diagnosis without further testing and validation.
“Alzheimer’s research has
greatly evolved over the past quarter of a century. Bringing the
diagnostic guidelines up to speed with those advances is both a
necessary and rewarding effort that will benefit patients and accelerate
the pace of research,” said National Institute on Aging Director Richard
J. Hodes, M.D.
“We believe that the
publication of these articles is a major milestone for the field,” said
William Thies, Ph.D., chief medical and scientific officer at the
Alzheimer’s Association.
“Our vision is that this
process will result in improved diagnosis and treatment of Alzheimer’s,
and will drive research that ultimately will enable us to detect and
treat the disease earlier and more effectively. This would allow more
people to live full, rich lives without—or with a minimum of—Alzheimer’s
symptoms.”
The new guidelines appear
online April 19, 2011 in Alzheimer’s & Dementia: The Journal of the
Alzheimer’s Association.
They were developed by expert
panels convened last year by the National Institute on Aging (NIA), part
of the NIH, and the Alzheimer’s Association. Preliminary recommendations
were announced at the Association’s International Conference on
Alzheimer’s Disease in July 2010, followed by a comment period.
Guy M. McKhann, M.D., Johns
Hopkins University School of Medicine, Baltimore, and David S. Knopman,
M.D., Mayo Clinic, Rochester, Minn., co-chaired the panel that revised
the 1984 clinical Alzheimer’s dementia criteria. Marilyn Albert, Ph.D.,
Johns Hopkins University School of Medicine, headed the panel refining
the MCI criteria. Reisa A. Sperling, M.D., Brigham and Women’s Hospital,
Harvard Medical School, Boston, led the panel tasked with defining the
preclinical stage. The journal also includes a paper by Clifford Jack,
M.D., Mayo Clinic, Rochester, Minn., as senior author, on the need for
and concept behind the new guidelines.
The original 1984 clinical
criteria for Alzheimer’s disease, reflecting the limited knowledge of
the day, defined Alzheimer’s as having a single stage, dementia, and
based diagnosis solely on clinical symptoms. It assumed that people free
of dementia symptoms were disease-free. Diagnosis was confirmed only at
autopsy, when the hallmarks of the disease, abnormal amounts of amyloid
proteins forming plaques and tau proteins forming tangles, were found in
the brain.
Since then, research has
determined that Alzheimer’s may cause changes in the brain a decade or
more before symptoms appear and that symptoms do not always directly
relate to abnormal changes in the brain caused by Alzheimer’s. For
example, some older people are found to have abnormal levels of amyloid
plaques in the brain at autopsy yet never showed signs of dementia
during life. It also appears that amyloid deposits begin early in the
disease process but that tangle formation and loss of neurons occur
later and may accelerate just before clinical symptoms appear.
To reflect what has been
learned, the National Institute on Aging/Alzheimer’s Association
Diagnostic Guidelines for Alzheimer’s Disease cover three distinct
stages of Alzheimer’s disease:
● Preclinical –
The preclinical stage, for
which the guidelines only apply in a research setting, describes a phase
in which brain changes, including amyloid buildup and other early nerve
cell changes, may already be in process. At this point, significant
clinical symptoms are not yet evident. In some people, amyloid buildup
can be detected with positron emission tomography (PET) scans and
cerebrospinal fluid (CSF) analysis, but it is unknown what the risk for
progression to Alzheimer’s dementia is for these individuals. However,
use of these imaging and biomarker tests at this stage are recommended
only for research. These biomarkers are still being developed and
standardized and are not ready for use by clinicians in general
practice.
● Mild Cognitive
Impairment (MCI) –
The guidelines for the MCI
stage are also largely for research, although they clarify existing
guidelines for MCI for use in a clinical setting. The MCI stage is
marked by symptoms of memory problems, enough to be noticed and
measured, but not compromising a person’s independence. People with MCI
may or may not progress to Alzheimer’s dementia.
Researchers will particularly
focus on standardizing biomarkers for amyloid and for other possible
signs of injury to the brain. Currently, biomarkers include elevated
levels of tau or decreased levels of beta-amyloid in the CSF, reduced
glucose uptake in the brain as determined by PET, and atrophy of certain
areas of the brain as seen with structural magnetic resonance imaging
(MRI). These tests will be used primarily by researchers, but may be
applied in specialized clinical settings to supplement standard clinical
tests to help determine possible causes of MCI symptoms.
● Alzheimer’s Dementia –
These criteria apply to the
final stage of the disease, and are most relevant for doctors and
patients. They outline ways clinicians should approach evaluating causes
and progression of cognitive decline. The guidelines also expand the
concept of Alzheimer’s dementia beyond memory loss as its most central
characteristic.
A decline in other aspects of
cognition, such as word-finding, vision/spatial issues, and impaired
reasoning or judgment may be the first symptom to be noticed. At this
stage, biomarker test results may be used in some cases to increase or
decrease the level of certainty about a diagnosis of Alzheimer’s
dementia and to distinguish Alzheimer’s dementia from other dementias,
even as the validity of such tests is still under study for application
and value in everyday clinical practice.
The panels purposefully left
the guidelines flexible to allow for changes that could come from
emerging technologies and advances in understanding of biomarkers and
the disease process itself.
“The guidelines discuss
biomarkers currently known, and mention others that may have future
applications,” said Creighton H. Phelps, Ph.D., of the NIA Alzheimer’s
Disease Centers Program. “With researchers worldwide striving to
develop, validate and standardize the application of biomarkers at every
stage of Alzheimer’s disease, we devised a framework flexible enough to
incorporate new findings.”
About Information Sources:
The Alzheimer's Association is
the world’s leading voluntary health organization in Alzheimer’s care,
support and research. Their mission is to eliminate Alzheimer’s disease
through the advancement of research; to provide and enhance care and
support for all affected; and to reduce the risk of dementia through the
promotion of brain health. For more information, visit
www.alz.org. Media contact is Niles Frantz at 312-335-5777 or
niles.frantz@alz.org.
The National Institute on
Aging leads the federal government effort conducting and supporting
research on aging and the health and well being of older people. The NIA
provides information on age-related cognitive change and
neurodegenerative disease specifically at its Alzheimer’s Disease
Education and Referral (ADEAR) Center at
www.nia.nih.gov/Alzheimers For more on health and on aging
generally, go to
www.nia.nih.gov. To sign up for e-mail alerts about new findings or
publications, please visit either website.
About the National Institutes
of Health (NIH): NIH, the nation's medical research agency, includes 27
Institutes and Centers and is a component of the U.S. Department of
Health and Human Services. NIH is the primary federal agency conducting
and supporting basic, clinical, and translational medical research, and
is investigating the causes, treatments, and cures for both common and
rare diseases. For more information about NIH and its programs, visit
www.nih.gov.
What other news sources
are saying:
The emphasis on the need to
diagnose Alzeheimer's during its earliest stages is also evident in
Congress, where legislation introduced this month would create new,
specific Medicare cost codes for early-disease diagnosis to address
these steps, including the discussions between the physician and
caregivers.
The New York Times: Guidelines Allow Earlier Definition Of
Alzeheimer's
The drive to diagnose Alzheimer's before it has progressed into profound
dementia is also reflected in a bill introduced in Congress this month,
which would create specific Medicare cost codes for Alzheimer's
diagnosis, including steps involving discussions between the patient's
doctor and caregivers, a recognition that keeping family members
well-informed can result in better planning and care (Belluck, 4/19).
The Associated Press: New Guidelines Define Pre-Alzheimer's Disease
The first new guidelines for diagnosing Alzheimer's disease in nearly 30
years establish earlier stages of the mind-robbing disease, paving the
way for spotting and possibly treating these conditions much sooner than
they are now. The change reflects a modern view that Alzheimer's is a
spectrum of mental decline, with damage that can start many years before
symptoms appear. The new guidance describes three phases: early brain
changes, mild cognitive impairment and full-blown Alzheimer's (Marchione,
4/19).
Chicago Sun Times: New Guidelines For Identifying Alzheimer's Before
Symptoms Occur
Medical experts have issued new guidelines for diagnosing Alzheimer's
disease that, for the first time, attempt to identify the hallmarks of
the disease before symptoms occur. The original guidelines, published in
1984, dealt only with diagnosing Alzheimer's once a person started
showing signs of dementia. Since then, new discoveries have shown the
disease can cause changes in the brain a decade or more before symptoms
appear (Thomas, 4/19).
New Report, New Facts for Baby
Boomers on AD from Alzheimer’s Association
● The new report,
"Generation
Alzheimer's: The Defining Disease of the Baby Boomers," sheds light
on a crisis that is no longer emerging – but here.
● Many baby
boomers will spend their retirement years either with
Alzheimer's or caring for someone who has it.
● An estimated 10
million baby boomers will develop
Alzheimer's.
● Starting this
year, more than 10,000 baby boomers a day will turn 65. As these baby
boomers age, one of out of eight of them will develop Alzheimer’s – a
devastating, costly, heartbreaking disease. Increasingly for these baby
boomers, it will no longer be their grandparents and parents who have
Alzheimer’s – it will be them.
● "Alzheimer’s
is a tragic epidemic that has no survivors. Not a single one," said
Harry Johns, president and CEO of the
Alzheimer’s Association. "It is as much a thief as a killer.
Alzheimer’s will darken the long-awaited retirement years of the one
out of eight baby boomers who will develop it. Those who will care for
these loved ones will witness, day by day, the progressive and
relentless realities of this fatal disease. But we can still change that
if we act now."
● According to the
new Alzheimer’s Association report,
"Generation Alzheimer’s," it is expected that 10 million baby
boomers will either die with or from Alzheimer’s, the only cause of
death among the top 10 in America without a way to prevent, cure or even
slow its progression. But, while Alzheimer’s kills, it does so only
after taking everything away, slowly stripping an individual’s autonomy
and independence. Even beyond the cruel impact
Alzheimer’s has on the individuals with the disease,
Generation Alzheimer’s also details the negative cascading effects
the disease places on millions of caregivers. Caregivers and families go
through the agony of losing a loved one twice: first to the ravaging
effects of the disease and then, ultimately, to actual death.
● "Most people
survive an average of four to six years after a diagnosis of
Alzheimer’s disease, but many can live as long as 20 years with the
disease. As the disease progresses, the person with dementia requires
more and more assistance with everyday tasks like bathing, dressing,
eating and household activities," said Beth Kallmyer, senior director of
Constituent Relations for the
Alzheimer’s Association. "This long duration often places
increasingly intensive care demands on the nearly 15 million family
members and friends who provide unpaid care, and it negatively affects
their health, employment, income and financial security."
● In addition to
the human toll, over the next 40 years
Alzheimer’s will cost the nation $20 trillion, enough to pay off the
national debt and still send a $20,000 check to every man, woman and
child in America. And while every 69 seconds someone in America develops
Alzheimer’s disease today, by 2050 someone will develop the disease
every 33 seconds - unless the federal government commits to changing the
Alzheimer’s trajectory.
● "Alzheimer’s
– with its broad ranging impact on individuals, families, Medicare and
Medicaid - has the power to bring the country to its financial knees,"
said Robert J. Egge, vice president of Public Policy of the Alzheimer’s
Association. "But when the federal government has been focused,
committed and willing to put the necessary resources to work to confront
a disease that poses a real public health threat to the nation – there
has been great success. In order to see the day where Alzheimer’s is no
longer a death sentence, we need to see that type of commitment with
Alzheimer’s."
The full text of the
Alzheimer’s Association’s "Generation Alzheimer’s" report can be
viewed at
www.alz.org/boomers.
