Confusion about Alzheimer's Diagnostic Guidelines and Clinical Care

Contributed by: Dennis Fortier, President, Medical Care Corporation
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The press is currently overflowing with coverage of the proposed changes to the outdated guidelines for diagnosing Alzheimer's disease. Most of the articles I have read have taken a sensationalistic and misleading slant. It may be superficially interesting to emphasize that early identification of AD will benefit drug makers, but that should not overshadow the real clinical benefit of earlier intervention.

Facts in a Nutshell
Current guidelines dictate that a person who consults a physician and complains of memory loss does not have AD until they become demented. Physicians can look for other causes of memory loss, such as depression, stroke, or thyroid disorder, and treat any problems they find. However, if nothing is found, and AD is strongly suspected, the guidelines prevent an actual diagnosis and treatment until the patient's symptoms progress to the dementia stage. The new guidelines would allow physicians to identify the disease at an earlier, and perhaps more treatable, stage of progression.

This point, that our current practice of late diagnosis is partially driven by outdated diagnostic standards, is highlighted in a report today from the Medical Research Council in the UK. This report clearly shows that primary care physicians are waiting too long to diagnose dementing illnesses and therefore, not treating them optimally.

I understand the mistrust of big pharma; they've earned their reputation. But I also understand that the effort to contain the growing Alzheimer's problem will absolutely enrich those with a piece of the solution. Don't forget that it will also diminish returns for those who currently profit from caring for demented patients.

Alzheimer's disease starts with a long slow period of accumulating pathology that is still not well understood. The current practice of waiting for clear symptoms before diagnosing and treating the disease has proven disastrous because too much brain damage occurs prior to the emergence of definitive clinical signs.

Merely recognizing that the disease is underway prior to full-blown dementia is not a greedy plot underwritten by the pharmaceutical and imaging industries; it is a scientifically sound approach to improving care in this field. It will enable more timely intervention and a clearer understanding of treatment efficacy with currently approved approaches.

Yes, we need to understand the pathology better and yes, we need new treatments that stop or slow disease progression; but we will never get those if we don't look at the disease clearly. Adhering to the current guidelines that deny the presence of AD prior to the patient becoming demented is a barrier to progress.

Is Memory Loss Treatable?

Contributed by: Dennis Fortier, President, Medical Care Corporation
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This is a common question that needs to be recast before it can be answered in any useful way.

To explore the question as posed, we must start with this other question: What is the cause of the Memory Loss you wish to treat? Once we have that information at hand, we can properly respond.

The point of this post, and of this recent article from KABC-TV in Los Angeles, is that there are many medical conditions that can cause memory loss. While many seem people to be most acutely aware of Alzheimer's disease, other common conditions such as depression, thyroid disorders, and vitamin deficiency can also impair memory.

In terms of treatment efficacy, these latter three (depression, thyroid, and vitamin deficiency) can be treated with excellent results. Alzheimer's disease treatments are less effective but perhaps not as poor as many headlines would indicate. The key to delaying progressive symptoms of Alzheimer's is early intervention coupled with a robust treatment plan that includes prescription drugs but also emphasizes good nutrition, physical exercise, social engagement, and careful management of other conditions such as diabetes and hypertension.

Not every patient responds well to this treatment but many can delay progression of decline due to Alzheimer's disease for a meaningful period of years. As such, the simple answer to the question "Is Memory Loss Treatable?" must be "Yes". The degree of treatment success depends on the cause of the memory loss and individual factors related to the patient's health and genetics.

New Guidelines for Diagnosisng Alzheimer's Disease

Contributed by: Dennis Fortier, President, Medical Care Corporation
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As we write here often, late diagnosis is the key barrier to better treatment of Alzheimer's disease.

We routinely identify the disease after about 7 years of symptoms when irreversible brain damage has already occurred. Earlier intervention, even with today's modestly effective drugs, would be more beneficial if started earlier and combined with improved diet, regular physical exercise, and careful management of other medical conditions such as hypertension and diabetes.

One reason we have historically been slow to diagnose Alzheimer's is that the guidelines for making such a diagnosis included "dementia". That is to say, until the disease process has diminished a person's thinking capacity to a point where they can np longer function independently, they don't yet have Alzheimer's disease.

The proposed changes to the guidelines suggest that the disease is indeed present, and should indeed be treated, prior to the patient becoming so mentally debilitated. This makes great sense and I see the proposed changes as a winning strategy in the battle against this terrible illness.