There were already rumblings of this announcement a few months ago, but it’s now official. Teams of experts working through the Alzheimer’s Association and the National Institute on Aging of the National Institutes of Health have announced new criteria and guidelines to help doctors diagnose Alzheimer’s disease. These revisions are the first in almost 30 years of these guidelines.
The guidelines are included in four articles and include clinical diagnostic criteria for Alzheimer’s disease and mild cognitive impairment (MCI) due to Alzheimer’s disease. According to the Alzheimer’s Association, these articles “expand the definition of Alzheimer’s to include two new phases of the disease: (1) presymptomatic and (2) mildly symptomatic but pre-dementia, along with (3) dementia caused by Alzheimer’s. This reflects current thinking that Alzheimer’s begins creating distinct and measurable changes in the brains of affected people years, perhaps decades, before memory and thinking symptoms are noticeable.” In addition, the workgroups involved in this project proposed a research agenda for preclinical Alzheimer’s, including the use of biomarkers in Alzheimer’s dementia and MCI as well as studies on brain imaging.
Time.com's Alice Park reported the guidelines developed by expert teams encourage researchers to consider using blood tests that would be sensitive enough to identify abnormal levels of amolyloid as well as tests of spinal fluid that highlight protein during their studies of the presymptomatic stage. While stressing that these tests need to be validated by researchers, the team of experts are encouraging medical doctors to begin familiarizing themselves with these tests. The new guidelines developed by the expert teams also describe four levels of MCI that can assist doctors in determining which cases could progress into Alzheimer’s disease.
“The new guidelines reflect today’s understanding of how key changes in the brain lead to Alzheimer’s disease pathology and how they relate to the clinical signs of mild cognitive impairment and Alzheimer’s disease dementia,” said Creighton Phelps, Ph.D., program director of the Alzheimer’s Disease Centers Program at the National Institutes of Health on the Alzheimer’s Association website. “We are also beginning to be able to detect these changes at a preclinical stage, long before symptoms appear in many people. With further research on biomarkers, as set forth in the new guidelines, we may ultimately be able to predict who is at risk for development of mild cognitive impairment and Alzheimer’s dementia, and who would benefit most as interventions are developed.”
In the Time.com article, Park noted, “The guidelines may not make a significant difference in the everyday care of patients today, but they could lay the foundation for a fundamental shift in understanding and treating the disease tomorrow.” Based on my own experiences in watching my grandmother’s descent into dementia and my mom’s own battle with Alzheimer’s, I agree with Park’s assessment. For instance, our family had difficulty getting a good diagnosis of Alzheimer’s in my mom’s case. We finally learned that she had MCI, but were unaware that there was a possibility that this was a precursor to full-fledged Alzheimer’s disease.
More information that helps doctors make better diagnosis will lead to better information for the loved one facing Alzheimer’s disease as well as the family. And more knowledge of these early stages also will help researchers develop not only ways to refine ways to identify the presymptomatic stage and the mildly symptomatic stage that marks pre-dementia, but also may lead to identification of drugs and lifestyle interventions that can help slow and possibly stop this dreadful disease.
Published On: April 19, 2011