Progress Being Made in Developing Alzheimer's Criteria, Guidelines
It’s interesting to see how things transition. For instance, take dementia. My family tree indicates that one of my maternal relatives from four generations back died from what was then called “sundowners.” When my grandmother developed memory issues, she was described as having some form of dementia. Then my mom suffered some memory lapses and was eventually diagnosed with mild cognitive impairment in 2004, which eased her mind because she thought she didn’t have Alzheimer’s disease. Yet a year later, she was diagnosed with Alzheimer’s.
So there’s been a lot of progress in not only labelling Alzheimer’s, but also understanding it. And thanks to researchers who have studied these cognitive issues, new guidelines are being proposed to help diagnose dementia.
These guidelines, which were developed by the National Institute on Aging and the Alzheimer’s Association in 2011, suggest that there are three stages of Alzheimer’s disease. These proposed stages are:
- Preclinical Alzheimer’s disease. This stage coincides with measureable changes throughout the body. These changes are seen in the brain, the cerebrospinal fluid and/or biomarkers in the blood. However, people in this stage do not display noticeable symptoms of Alzheimer’s. However, the implementation of this recommendation is awaiting the completion of further research before formally establishing criteria that doctors can use to diagnose this stage of cognitive decline. I appreciate that the powers that be are taking this approach since there currently is not a treatment for this stage or for Alzheimer’s. Therefore, diagnosing someone with preclinical Alzheimer’s disease is not doing anyone any favors and, in my estimation, could lead to depression, anxiety and suicidal thoughts.
- Mild cognitive impairment due to Alzheimer’s disease. This stage involves noticeable changes in thinking that family members and friends can identify. However, the person who has mild cognitive impairment can still carry out their everyday activities. Almost 10-20 percent of people who are age 65 or older are believed to have some level of mild cognitive impairment. However, as I mentioned in a sharepost earlier in the month, not everyone who has mild cognitive impairment will progress to develop Alzheimer’s. Still, about 50 percent of people who complain about MCI symptoms end up developing some form of dementia within a four-year period. And the ones who seem to slide into dementia are those who have memory problem (as opposed to other issues, such as visual perception or complex decision making).
- Dementia due to Alzheimer’s disease. People who have this type of dementia have issues with memory, thinking and behavior that are noticeable to family members and friends. They are unable to function normally when doing activities required in daily life.
The other cool part of the proposed criteria and guidelines is that researchers are actually making substantial progress developing biomarker tests that can help identify cognitive decline. While they haven’t identified any biomarkers that have been validated by multiple studies that have a large number of participants, researchers are seeing potential in brain imaging through structural imaging (which looks at the shape, position and volume of the brain), functional imaging (which focuses on the use of sugar and oxygen by brain cells) and molecular imaging (which examines the changes at the cellular or chemical level that are linked to specific diseases).
Other biomarkers are also showing promise. For instance, proteins in the cerebrospinal fluid are of interest since researchers believe there may be changes of tau and beta-amyloid levels in this fluid when Alzheimer’s is in its earliest stages. Researchers also are studying whether there are changes in tau, beta-amyloid or other proteins found in the blood or urine that are linked to Alzheimer’s. Finally, researchers continue to explore genetic risk profiling as a way to predict Alzheimer’s disease.
Obviously, the hope is that through the scientific and health communities will get to a point where these tests can be administered early enough in either the preclinical or mild cognitive impairment stages. That way, individuals who are at risk of developing Alzheimer’s can be identified and be put on an individualized treatment plan that will modify – and hopefully, eventually stop – this terrible disease.
Primary Sources for This Sharepost:
Alzheimer’s Association. (ND). Alzheimer’s and dementia testing for earlier diagnosis.
Alzheimer’s Association. (2014). 2014 Alzheimer’s disease facts and figures.