Contributed by: Dennis Fortier, President, Medical Care Corporation
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I commonly encounter this question in the press, I hear it discussed at conferences, and physicians pose it to me on a regular basis. Despite the centrality of this question in so many forums of cognitive health, it is a nonsensical inquiry with inherent flaws. Additionally, it propagates a pernicious brand of confusion that I want to clarify today.
As per my earlier post, Mild Cognitive Impairment 101, there are many medical conditions that can cause a subtle cognitive deficit. Pondering whether or not MCI will "convert" to Alzheimer's Disease (AD) obscures the fact that MCI is a symptom of an underlying medical problem (not the problem itself). In fact, some MCI is actually caused by AD and therefore, the prospect of converting does not belong in a logical, informed discussion.
When MCI is present, the correct question is "what is the cause of the impairment?". If the answer is AD, then the folly of a conversion outcome is clear; the disease precedes the impairment and not vice-versa. If the MCI is caused by some other medical condition (depression, vascular disease, anxiety, etc.) then it is equally futile to consider whether or not it will convert to AD; these medical problems are separate and distinct. That is not to say that such a particular person will never get AD because they may. In fact, the medical condition causing their impairment might even confer a greater risk for AD, but the notion of "converting" from MCI to AD is illogical.
A good analogy would be to learn of a patient with excessive thirst and blurry vision and then wondering if these symptoms will ever "convert" to Diabetes. Most physicians would perform a diagnostic work-up, take note of the high blood sugar, and diagnose diabetes immediately. There would be no debate about whether or not the symptoms would covert to the disease -- they would conclude that the presence of the disease has caused the symptoms. We must do the same with MCI. That is, perform a work-up and identify the underlying cause of the symptoms so that the patient may benefit from timely intervention.
So why have I labeled this as "a pernicious brand of confusion"? Because the perpetration of the idea that MCI might or might not convert to AD prevents some (if not many) primary care physicians from proactively diagnosing the cause of MCI and treating it. Giving any credence to the notion that MCI is a sporadically progressive precursor to AD is a barrier to clarity and interferes with a higher standard of care in this field.
AD Treatment Perspective #3
Contributed by: Dennis Fortier, President, Medical Care Corporation
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Why is the press so nihilistic about the fact that there is no cure for Alzheimer’s disease and that current treatment options only manage the symptoms? We can say the same about diabetes, hypertension, and high-cholesterol. True, we are highly effective at managing these other chronic conditions and only moderately so for AD, but I am alarmed at how broadly the “nothing can be done” mantra has been embraced. Much can be done.
________________________________________________
Why is the press so nihilistic about the fact that there is no cure for Alzheimer’s disease and that current treatment options only manage the symptoms? We can say the same about diabetes, hypertension, and high-cholesterol. True, we are highly effective at managing these other chronic conditions and only moderately so for AD, but I am alarmed at how broadly the “nothing can be done” mantra has been embraced. Much can be done.
When will we get a cure for Alzheimer's Disease?
Contributed by: Dennis Fortier, President, Medical Care Corporation
________________________________________________
There is no definitive answer to this ubiquitous question. The best we can do is to watch the advance of science through the published literature and to follow the clinical trials from which the answer will one day emerge.
While the pathology of Alzheimer's disease is still not well understood, scientists have developed a host of well-grounded theories. Several treatment agents, based on those theoretical foundations, are currently in development or in clinical trial.
Here is an excellent summary of the leading treatment hypotheses as well as the development status of the most promising treatment agents. Some of the information is a bit technical but I think the lay person can read this and get a good sense of the time frame for a meaningful advance. It should be clear that no cure is imminent but equally clear that several treatment agents are in advanced stages of clinical trial.
Predicting the results of these trials is hampered by our vague understanding of what causes Alzheimer's Disease. On the bright side, one or another of these agents may be surprisingly effective in altering the disease course and could be available in less than five years. On the dark side, they may all turn out to be ineffective in which case we would be more than five years away from a meaningful new medication. Only time will tell.
In the meantime, we all need to be proactive in identifying and managing our risk factors for cognitive decline (the topic of an upcoming blog) and physicians must be vigilant about acting on evidence or suspicion of decline among their patients. Until better treatments are discovered, we must intervene as early as possible with the current medications to maximally delay the progression of Alzheimer's disease.
________________________________________________
There is no definitive answer to this ubiquitous question. The best we can do is to watch the advance of science through the published literature and to follow the clinical trials from which the answer will one day emerge.
While the pathology of Alzheimer's disease is still not well understood, scientists have developed a host of well-grounded theories. Several treatment agents, based on those theoretical foundations, are currently in development or in clinical trial.
Here is an excellent summary of the leading treatment hypotheses as well as the development status of the most promising treatment agents. Some of the information is a bit technical but I think the lay person can read this and get a good sense of the time frame for a meaningful advance. It should be clear that no cure is imminent but equally clear that several treatment agents are in advanced stages of clinical trial.
Predicting the results of these trials is hampered by our vague understanding of what causes Alzheimer's Disease. On the bright side, one or another of these agents may be surprisingly effective in altering the disease course and could be available in less than five years. On the dark side, they may all turn out to be ineffective in which case we would be more than five years away from a meaningful new medication. Only time will tell.
In the meantime, we all need to be proactive in identifying and managing our risk factors for cognitive decline (the topic of an upcoming blog) and physicians must be vigilant about acting on evidence or suspicion of decline among their patients. Until better treatments are discovered, we must intervene as early as possible with the current medications to maximally delay the progression of Alzheimer's disease.
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