New Alzheimer's Diagnostic Guidelines

[Guest guest]

These new guidelines for diagnosing Alzheimer's Disease have been in the works

for awhile. One new component is that " the guidelines specify that Alzheimer's

biomarkers — including abnormal levels of the proteins amyloid and tau, and

shrinkage of certain brain areas — should not yet be put into widespread use,

but used only with patients enrolled in clinical trials. "

" The guidelines also clarify diagnosis criteria for people with dementia

symptoms, distinguishing Alzheimer's from other dementias, including vascular,

fronto-temporal and Lewy body. And they note that the earliest symptom of

Alzheimer's dementia is not always memory loss, but could be mood changes or

problems with language, spatial perception or reasoning. "

I haven't had a chance yet to look through the new guidelines to learn about

these clarifications. You can find a link to the new guidelines and an overview

of them on the Alzheimer's Association website here:

http://www.alz.org/research/diagnostic_criteria/overview.asp

The article also mentions that there is legislation in Congress that 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. "

Of course it would be nice to have those discussions paid for as part of a

medical appointment about any disorder, not just AD.

Robin

http://www.nytimes.com/2011/04/19/health/19alzheimer.html

Guidelines Allow Earlier Definition of Alzheimer's

By Pam Belluck

New York Times

Published: April 19, 2011

For the first time in 27 years, the definition of Alzheimer's disease is being

recast in new medical guidelines that reflect fast-mounting evidence that it

begins ravaging the brain years before the symptoms of dementia.

The guidelines, to be issued Tuesday by the National Institute on Aging and the

Alzheimer's Association, divide the disease into three stages: a phase when

dementia has developed, a middle phase in which mild problems emerge but daily

functions can still be performed, and the most recently discovered phase, in

which no symptoms are evident but changes are brewing in the brain.

" We're redefining Alzheimer's disease and looking at this in a different way

than had ever been done, " said Creighton Phelps, director of the National

Institute on Aging's Alzheimer's Disease Centers Program. " I think we're going

to start to identify it earlier and earlier. "

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.

" Early diagnosis is really the key to this, " said Representative J.

Markey, Democrat of Massachusetts and a sponsor of the bill. " Oftentimes family

members notice the symptoms in their loved ones, but it's only years later that

they get diagnosed or understand what resources are available. "

The most striking addition to the guidelines concerns methods that assess brain

changes involved in Alzheimer's, including brain scans and tests of cerebral

spinal fluid. Such methods measure what are called biomarkers, physiological

indicators that someone is likely to develop dementia eventually, just as

cholesterol and blood pressure are biomarkers of impending heart disease.

For now, the guidelines specify that Alzheimer's biomarkers — including abnormal

levels of the proteins amyloid and tau, and shrinkage of certain brain areas —

should not yet be put into widespread use, but used only with patients enrolled

in clinical trials.

That is because scientists cannot yet standardize the results of the tests, or

know " what measure is truly abnormal and what measure is not, " said Marilyn

Albert, director of the s Hopkins Alzheimer's Disease Research Center, and a

leader of one working group that developed the new guidelines.

As many as a third of people with amyloid plaques in their brains, for example,

have not developed Alzheimer's symptoms by the time they die. The guidelines

also urge caution because there is currently no drug known to halt or

significantly delay the onset of symptoms, so people told they are likely to get

Alzheimer's have no effective medication to take.

" We don't have enough information about what to tell people, " said Dr.

DeKosky, dean of the University of Virginia medical school, who participated in

one of the working groups. " Until you can tell a clinician, `If you do this test

you have X amount of reliability and to do that will make a difference in the

life of your patient' — until then, it remains in the lab. "

But the guidelines reflect a sense in the medical community that the moment when

science will have more specific knowledge about biomarkers is not that far off.

They are intended to encourage more research so that drugs can be developed to

attack early brain changes and to identify people who might benefit from such

drugs when they become available.

The goal, said Thies, chief medical and scientific officer for the

Alzheimer's Association, is " extending the range of our ability to investigate

this disease and eventually find the treatment that is going to be so necessary

to avoid the epidemic of Alzheimer's disease that we see facing us over the next

40 years. "

In the short term, the biggest impact is likely to be seen with people who fall

into the middle phase, those with mild cognitive impairment linked to

Alzheimer's. Experts say there are at least as many people experiencing this

phase as the 5.4 million people estimated to have Alzheimer's dementia. And they

expect others to now ask their doctors if they are showing signs of mild

impairment, which include experiencing some difficulty or inefficiency with

memory, attention or other mental faculties, while still being able to function

independently.

Dr. Albert said that if patients with symptoms of mild cognitive impairment

wanted to " increase the certainty " of the diagnosis by getting a brain scan or

spinal fluid test, they should obtain such tests in a research trial so they

have a better chance of getting accurate results.

The guidelines also clarify diagnosis criteria for people with dementia

symptoms, distinguishing Alzheimer's from other dementias, including vascular,

fronto-temporal and Lewy body. And they note that the earliest symptom of

Alzheimer's dementia is not always memory loss, but could be mood changes or

problems with language, spatial perception or reasoning.

Dr. Pierre Tariot, director of the Banner Alzheimer's Institute in Phoenix, who

was not involved in drafting the guidelines, called them " a step in the right

direction " that he hoped would not be " misconstrued " as a sign that biomarker

tests are further along than they are. He added, " The notion that Alzheimer's

disease is a continuum that has an extensive pre-symptomatic phase is a very

important message to get out. "

Dr. Phelps said it would hardly be the last word from the medical community on

Alzheimer's.

" We're not drawing a line and saying this is it, " Dr. Phelps said. " What we're

saying is this is the best of our knowledge and we're not going to wait 27 years

to revisit these again. "