HEALTH: Alzheimer’s disease: New guidelines for the diagnosis of Alzheimer’s disease published for first time in 27 years

Across the United States, every 69 seconds someone is diagnosed with Alzheimer’s disease, according to the Alzheimer’s Association. Nearly 5.5 million already have been diagnosed with Alzheimer’s.

Last month, for the first time in more than a quarter century new medical guidelines for the disease were released. Herald reporter Ann Bailey talked with Michelle Barclay, Alzheimer’s Association of Minnesota-North Dakota vice president of programs, about the new guidelines.

Here is an edited version of their conversation:

Q. Why were new guidelines written?

A. This is the first time in 27 years that new criteria and guidelines for the diagnosis of Alzheimer’s have been published. We’ve learned a lot about the disease since 1984.

Q. How were the new guidelines developed?

A. Three expert work groups were spearheaded by the Alzheimer’s Association and the National Institute on Aging or NIA led the project. One work group looked at the pre-clinical disease, one looked at mild cognitive impairment due to Alzheimer’s disease and the third focused on the clinical criteria for Alzheimer’s disease.

The pre-clinical stage is where people have Alzheimer’s in their brain but there are no symptoms. Preclinical disease can last decades before symptoms appear. When people begin to show symptoms, they have reached the stage of mild cognitive impairment.

In that period, people have disturbance in memory that is more significant than normal memory changes associated with aging. Although Mild Cognitive Impairment or MCI includes problems with short-term memory, people are able to compensate for the memory loss and carry out day to day activities.

The third phase is Alzheimer’s disease, a gradually progressive illness that causes problems with memory, thinking and behavior, and significantly impacts daily life.

Q. What are some differences between the new guidelines and the old guidelines?

A. Two notable differences from the current diagnostic criteria are: 1) formalization of different stages of the disease, and 2) incorporation of biomarkers.

The new guidelines expand the definition of Alzheimer’s to include two new phases: (a) pre-symptomatic and (b) mildly symptomatic (but pre-dementia) stages of the disease, along with the current notion of (c) dementia caused by Alzheimer’s. This reflects current thinking that Alzheimer’s begins creating distinct and measurable changes in the brain years, perhaps decades before memory and thinking symptoms are noticeable.

A biomarker is something in the body that you can measure 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. Both cerebrospinal fluid and imaging such as PET scans and MRI) are being tested as possible biomarkers for Alzheimer’s disease.

Identifying the biomarkers and seeing which people eventually get Alzheimer’s will help to better understand the connections between the pre-clinical stages and Alzheimer’s stages. If Alzheimer’s can be diagnosed in the pre-clinical stage, then there’s potential to develop treatments before symptoms appear. Now people are usually diagnosed in the mid-stages of Alzheimer’s. Research shows a need to diagnose Alzheimer’s earlier before the extensive brain damage occurs.

This is really important. If we can focus on research and find a treatment before symptoms occur, we could not only save the human toll that this takes, but also substantial costs.

This is a great time for people to get involved in research and help to find a cure. These guidelines, I think are exciting because they offer hope for a time we can treat this disorder before it actually happens. That has never been a possibility before.

The pre-clinical guidelines outline a mechanism for the field it move in that direction. It’s a very exciting time for research because we really need that now. We have tidal wave of people coming who will have this disease and we have to find a way to stop it.

Certainly, need more tools in our tool box to fight this thing.

Q. What are those tools?

A. We need more money. Cancer and heart disease, death rates are going down so are stroke; prostate cancer; breast cancer and others. Deaths from Alzheimer’s disease rose 66 percent between 2000 and 2008.

Alzheimer’s disease is rising. It’s the lowest funded illness in terms of research.

The issue with Alzheimer’s disease is that the greatest risk factor is age. Baby boomers will reach the age of greatest risk this year. Once you hit age 65, the risk is one in 10. When you hit 85, the risk is up to five in 10.

There’s a wave of older people coming. We, as a society, need to make an investment in this… This is like the polio of our time. It’s a family disease. It impacts the whole community.

Tags: life, health, disease