The Most Overlooked Opportunity in the Field of Alzheimer’s Care

Contributed by: Dennis Fortier, President, Medical Care Corporation

We all know about the obvious problems associated with Alzheimer's disease (AD). The media carry daily stories about the aging of the population (nearly 10,000 baby boomers turning 65 each day).  We are also inundated with messages about how current medications seem to be minimally effective against this poorly understood disease. Certainly, our limited ability to treat a disease that affects a burgeoning, elderly population makes for dire headlines.

However, there is a third problem that seems to be commonly overlooked in this conversation.

Late Intervention: Both Problem and Opportunity
This third problem is less obvious than the aging population and minimally effective treatment, but solving it will greatly mitigate the impact of these more widely noted themes. The problem is the unacceptably late intervention that we practice against this progressive disease. We routinely diagnose AD near end-stage pathology.

There is a fair degree of variability from case to case but, on average, AD follows a 14-year course from the onset of subtle symptoms until death. This usually includes a 7-year period of mild cognitive impairment (MCI) during which patients remain independent and able to care for themselves. The MCI stage is typically followed by a 7-year period of worsening dementia. In most instances (95% of instances according to one study), AD is first diagnosed during the mild or moderate dementia stages. This correlates roughly to years 8 through 11 on the 14-year time line.

We are dealing with a progressive disease that ravages the brain with each passing year and, on average, we are not intervening with treatment until end-stage pathology and massive brain damage have occurred. Yes, we need better treatments, but we can improve outcomes meaningfully by treating earlier with the currently approved interventions.

Alas, earlier intervention is a sensible but slippery goal. This is because early-stage AD patients, those in the MCI stage, have only mild symptoms. In this way, they look to a physician precisely like the multitudes of "normally aging" patients who have accurately sensed a slowing of their word or name recall, and are needlessly worried about AD. As you might imagine, these two types of patients are difficult to distinguish from one another.

Major Challenge: Discernment of Healthy Patients from Unhealthy Patients
Since the chances are high that a 65-year old patient complaining of subtle memory decline does not have early stage AD, such concerns are usually not closely evaluated until symptoms worsen considerably. This has lead to the current practice of intervening only after the disease has progressed to the dementia stage when, by definition, the symptoms are quite pronounced.

Today, however, there are short neuropsychological assessments, scored with sophisticated computer algorithms, that accurately distinguish MCI from normal aging. These assessment tools perform an efficient traffic control function to escort the worried well out of the health care system, while retaining those with objectively measured deficits for a comprehensive diagnostic work-up. With such brief and inexpensive assessment tools, physicians can now intervene earlier and treat memory disorders like AD before unnecessary brain damage has occurred. Doing so will foster a major improvement in standards of care for Alzheimer's patients.

Education and Awareness: Next Opportunities for Better Care
In this regard, the major challenge to an immediate improvement in care becomes one of awareness and education for the public and for primary care physicians. This is difficult but perhaps more certain in its achievability than the more scientifically challenging process of fully understanding AD and developing treatment agents that will halt its progression.

We need to tackle this disease from all angles and getting an earlier start with intervention seems to be an immediately graspable approach that does not, in my opinion, get enough attention in the field.

9 comments :

  1. Totally on the mark. Thank you for this informative article.

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  2. So it really requires a 2 pronged approach:
    educating primary care physicians AND the public.
    I am so tired of hearing people say, "I don't want to know if I have Alzheimer's so I just won't get checked out."
    They lose so much precious time.

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  3. My father died of Alzheimer's. It was horrible for all of us but especially for him. Both my brother (65) and I (63) show signs of early memory loss even though I am still working and doing all that I can to exercise my brain (games, puzzles, etc). I discussed your article and MCI testing with my physician last week and he said he'd never heard of it and told me the loss of words and names that I am experiencing is normal for my age. I am printing your article and faxing it to him. Thank you! You are right. We do need more education. Our physicians need more education. I have a wonderful physician who is usually aware and current but even he is not aware.

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  4. To Annonymous: Physicians are bombarded with commercial messages, some of which feature exaggerated claims of efficacy, and they really cannot be expected to stay on top of all advances in every field. You might help your physician by directing him to Medical Care Corporation's website (www.mccare.com) where he can evaluate the evidence and satisfy himself about the utility of the MCI Screen.

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  5. I have been diagnosed with early Alzheimer's. I
    am glad that I took the 8 hour test and found
    out sooner than later. I am now on disability
    as I am/was an RN and can no longer work. I
    wish I had known more about the disease; my father was disagnosed with it as well, but he
    was quite elderly before it was noticed. I
    am attempting to use turmeric and other things
    that I have read about and am eating better than
    before. It has broken my "heart" because I am
    only 63 years old and really thought I was going
    have a great retirement. However, I am doing
    all I can to keep active and make the most of
    of what time I have. I cannot volunteer or
    work or I will lose my disability, and that is
    a shame as nothing is going to change, but I
    could be at least helping others while I can.
    I would really like to be of some help to others
    during the "good" time I still have. Thank
    you for all the info. I have found on your blogs.

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  6. Christine Baum Van RyzinJune 18, 2010 at 10:20 PM

    Early intervention is a must. There are a number of us with early-onset memory and cognitive challenges who are using the perscribed EMSAM Selegiline Transermal Patch by Somerset. Not only is it neuroprotective, it is helping with cognitive symptoms (I can now make decisions and talk clearly), my brain is working faster, and physically it is helping with gait, strength, fatigue, etc. Currently, we change the patch every 24 hours. There is a new study out that suggests those in the earliest stages of decline use the patch changing it in 48 hour interviles, especially because of the neuroprotective factor. Selegiline has been used in Europe for many years for treating Alzheimer's, Parkinsonian symptoms, and depression. Currently it is FDA approved for Parkinsonian symptoms and depression in the US. But as a user of EMSAM, I see it greatly improving my quality of life both mentally and physically.

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  7. Christine, thanks for the info on Selegiline. We used it for Dad's Parkinson's, but I didn't know it was also used for Alzheimer's (which my mother suffers from). Will check it out.

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  8. How does one go about getting checked out when they know there's a problem? Should you get tests for all the genes? How do you find a dr. who knows the best ways to treat it? How do you know if they really know what they are doing? Are there centers that specialize in treating Alzheimer's? Sadly, I've had doctors who didn't know(or didn't care)about regular health issues in the past. It's scary out there!!

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  9. To Anonymous: If you are sure you have a memory problem, insist with your primary care physician that it be diagnosed. This will likely involve a thorough review of your medical history and current medications, assessment for depression and anxiety disorders, standard blood work, and perhaps an MRI scan of your brain. There are many known causes of memory loss, Alzheimer's is only one of them. I doubt your physician will immediately order any genetic testing, but that is not necessarily a poor level of care. It makes sense to check for other common problems first, an then follow a sequence of progressively deeper diagnostic steps. Also, if you feel that your physician is not taking your concerns seriously, go to a different physician. It is up to you to demand a high level of care. Good luck.

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