Apr 272011

New Diagnositc Guidelines for Alzheimer's Published in the Journal of the Alzheimer's AssociationFor the first time in 27 years, new criteria and guidelines for the diagnosis of Alzheimer’s disease have been published by three expert workgroups spearheaded by the Alzheimer’s Association and the National Institute on Aging (NIA) of the National Institutes of Health (NIH). If you have been diagnosed with Alzheimer’s or have a loved one with the disease, you may be asking, what does this mean for me?

In the short term, the new guidelines probably won’t affect how you and your loved ones interact with your doctor regarding the disease. For example, there are no new tests that you should be asking for at this time. However, this is a landmark event for the field. We believe this moves us significantly closer to our goal of eventually detecting and treating Alzheimer’s disease before people experience the devastating symptoms of loss of memory and thinking abilities.

Here’s how: An overarching goal of Alzheimer’s doctors and researchers, the Alzheimer’s Association, and the NIA is to enable people to live long, healthy lives free of the disability caused by Alzheimer’s. There is consensus that treating the disease before symptoms occur is how this goal will be met. However, no generally accepted way exists to identify Alzheimer’s at its presymptomatic — and potentially most treatable — stage. The new guidelines address this in two notable ways.

1.    New Stages of the Disease Defined

First, the new guidelines 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.

According to the authors of the new diagnostic guidelines, in order to facilitate the possibility of future presymptomatic treatment of Alzheimer’s, it was important to define the disease from the earliest changes in the brain, not only the observable, symptomatic stages of the disease.

The new guidelines also update current criteria for diagnosing dementia caused by Alzheimer’s disease and mild cognitive impairment (MCI). People with MCI experience a decline in memory, reasoning or visual perception that’s measurable and noticeable to themselves or to others, but not severe enough to be diagnosed as Alzheimer’s or another dementia.

2. Biomarkers for Earlier Detection and Greater Diagnostic Accuracy

The new guidelines also establish a framework and a research agenda for using biomarkers (substances that reflect  biological changes in the brain associated with Alzheimer’s) to improve the accuracy of diagnosis of all three stages of the disease. A biomarker is a naturally occurring, measurable substance or condition in the body that reliably indicates the presence or absence of disease or the risk of later developing a disease; for example, blood glucose levels are a biomarker of diabetes, and cholesterol levels are a biomarker of cardiovascular disease risk.

Doctors will not diagnose the new presymptomatic phase of Alzheimer’s until further research identifies the most reliable biomarkers indicating that Alzheimer’s is beginning to develop. Once reliable biomarkers are confirmed, they will also be used to more accurately distinguish “MCI due to Alzheimer’s disease” from MCI due to other causes. They will also be used to increase the accuracy of diagnosing dementia due to Alzheimer’s.

Results of both fluid (e.g., cerebrospinal fluid and blood) and brain imaging (e.g., magnetic resonance imaging and positron emission tomography) tests are being studied as possible biomarkers for Alzheimer’s. Two biomarker categories are identified in the criteria and guidelines: (1) biomarkers showing the level of beta-amyloid accumulation in the brain and (2) biomarkers showing that nerve cells in the brain are injured or actually degenerating.

Much additional research needs to be done to validate the application of biomarkers as they are proposed in the newly published criteria and guidelines. These studies are likely to take at least decade to accomplish. This highlights the need for a greater commitment to research, including increasing funding for Alzheimer’s research and recruiting more volunteers for Alzheimer’s clinical trials.

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  10 Responses to “New Guidelines for Diagnosing Alzheimer’s: What Do They Mean for You?”

  1. The guidelines state "Presently, the use of biomarkers to enhance certainty of AD pathophysiological process may be useful in three circumstances: investigational studies, clinical trials, and as optional clinical tools for use where available and when deemed appropriate by the clinician."

    So, can doctors use biomarkers for MCI? It looks like the guidelines say yes, under special circumstances "as deemed appropriate by my doctor". Both of my parents have AD, and I have MCI. I need the most accurate information possible in predicting my risks.

  2. After arguing with my mother's doctors for the last 5 years that her memory loss was not "normal aging" but the begining stages of alzheimer's, I can say that in her case the doctors were incredibly ignorant with regard to the early signs of AD. I understand that there are no definitive tests for detecting early stage AD but it is all the more important then for clinical doctors to listen to family members concerns and take them seriously. That's 5 years that she could have been on Aricept to slow the progession of the disease (but was not). As far as I can tell, these new guidelines do nothing to help the average clinical doctor detect early stages of AD. If doctors can't even recognize it when it's staring them in the face how can we expect them to pick up on the more subtle indicators. (By the way, the doctors were her internist and a neurologist who supposedly specialized in AD!)

    • Amy,
      As you’ve experienced, family and friends of people with dementia are often the most tuned in to cognitive decline and the first to notice when changes occur. As a result, input from family and trusted friends can play an important part in early diagnosis. If you’ve brought concerns regarding memory loss to a physician but have not been satisfied with the response, there is great value in getting a second opinion. It’s important to work with a physician you are comfortable with – and sometimes that means switching to a new care provider. If you need help finding a doctor with expertise in Alzheimer’s and dementia, your local Alzheimer’s Association chapter can provide a list of specialists in your community. You can find your local chapter through <a href="http://www.Alz.org,” target=”_blank”>www.Alz.org, as well as more information about diagnosing Alzheimer’s.

  3. My friend's HMO doctor told her she had ALZ after she was unable to repeat something he said quickly to her. (She says she was too scared to answer.) A few days later his nurse told her she did not have ALZ. Was his quickie only-verbal test sufficient to diagnse ALZ? Was his nurse just jollying her? Contradictory patient handling like this is infuriating. Has anybody else had this happen to them?

  4. My father-in-law's former primary care physician said he didn't believe in Alzheimer's disease – it was just "made up" to satisfy what was going on with Ronald Reagan and his memory issues years back. He stated that if it had not been for Reagan's declining memory, which he attributed to the normal aging process, everyone wouldn't be crying about Alzheimer's disease. This is why this health care provider is now a former physician.

  5. how early a detection is this? When patients first appear with signs? Or is this a possiblity of checking years and years before a patient is even mentally impaired? My father died due to complications of AD. Myself and my siblings have all questioned if we might be carrying that gene or if we will pass it on to our children. Is this something we can tell soon?

    • amamda there is a blood test that can have done to determine if you have the gene.i had the test done in 2008 and it came back 97% positive. i was diognoised with alz. i wwas put on aricpet. i was 51 years old. talk to your doctors. i hope this was helpful.

  6. My mother is 61 years old and has had severe memory loss over the past 2 years. Her doctor says she's too young and it's not ALZ because her memory loss isn't actual long term memory loss. She can't remember people's names and certain objects — like a lamp, door knob, microwave or light switch. Another great example is my father gave her a grocery list and the word vegetable was on it and she had to ask what vegetables are. Her doctors think it's stress related however, I disagree. Her doctor referred her to a Neurologist to get and MRI and the results came back no sign of ALZ. Can an MRI detect ALZ?

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  8. It says in this article that additional research will be done in order to validate the use of biomarkers to detect early signs of ADas well as MCI due to Alzheimer's. Hopefully after years of studies, the result will be positive–that the doctors will be able to detect Alzheimer's disease earlier. This may not mean that much for those who've been diagnosed with AD but hopefully this will bring something positive to other people.

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