Question: What is the difference between dementia and Alzheimer’s disease?
Answer: Dementia is the umbrella term for brain disorders
that cause a person to lose their ability to function normally
in daily life. Alzheimer’s disease is the most common, but
there are other dementias, such as vascular, Lewy body, etc.
Although we know Alzheimer’s dementia is distinct from
these other forms, in the early stages it may be difficult to
differentiate among them. Additionally, many older people
may have more than one condition, such as Alzheimer’s
disease combined with vascular disease and sometimes small
strokes.
That is one of the reasons why researchers hope one day to
develop an easy-to-administer, reliable and inexpensive
biomarker—a test that indicates harmful changes taking
place in the brain—that can be used in a doctor’s office. For
example, eventually there may be a simple blood test to help
diagnose Alzheimer’s disease.
Question: How was dementia diagnosed before these new
guidelines and what has changed?
Answer: The new guidelines do not dramatically alter the
current process doctors use to diagnose Alzheimer’s disease.
Dementia is still diagnosed based on significant and chronic
changes in a person’s thinking processes, or as a professional
would state, cognition. Healthcare providers speak with the
patient and family or caregivers, seeking observations about
changes in how the patient thinks, learns and remembers and
taking into consideration other potential causes of cognitive
decline—for example, medications, malnutrition,
dehydration, depression.
However, the new guidelines ask doctors to look beyond
just memory loss for additional symptoms that may mark
onset of the disorder, such as problems with judgment. And
the revised guidelines outline ways the healthcare provider
should approach evaluating the causes and progression of
cognitive decline. For example, healthcare providers are
made aware that mild cognitive impairment (MCI) may in
many cases progress to Alzheimer’s disease and that memory
impairment is not always the first symptom of Alzheimer’s.
Question: Where and how are biomarkers and new imaging
tests being used?
Answer: At this time, they are being used by researchers
investigating how brain imaging and body fluid analysis relate
to the changes taking place in the brain and whether the
tests can predict who is at risk for developing the clinical
symptoms associated with the disease. For clinicians in
research centers or with access to large medical centers,
fluid biomarker and imaging tests may be used in certain
cases. For example, they may be used to increase or
decrease the level of certainty about a diagnosis of
Alzheimer’s dementia and to distinguish Alzheimer’s
dementia from other dementias. But at this stage, the tests
are not available to primary care doctors because
investigators are still standardizing and evaluating their use.
Question: Why were the diagnostic criteria for Alzheimer’s
disease revised and who led the effort?
Answer: The diagnostic criteria had been in place for more
than 27 years and did not reflect the new knowledge that has
been gained regarding the progression of the disease. Thus,
the National Institute on Aging (NIA) at the National
Institutes of Health and the Alzheimer’s Association brought
together experts in clinical neuro- and behavioral science to
revise the criteria.
The new guidelines will help guide research and hopefully
speed the discovery of treatments to delay and/or prevent
Alzheimer’s disease. The guidelines also explain to clinicians
and the public our deeper understanding of the disease—that
it develops over decades, long before the first signs of
dementia appear; and for that reason, clinicians need to be
sensitive to early changes that may be associated with the
development of mild cognitive impairment.
Question: How will doctors use the updated guidelines to
better diagnose Alzheimer’s disease?
Answer: For the most part, doctors will consider Alzheimer’s
disease in an office setting pretty much as they have in the
past, but with updated knowledge about what to look for. A
major change for physicians is the consideration of mild
cognitive impairment, or MCI. People with MCI have
problems with memory or other cognitive functions that are
greater than normal for their age and education.
Some doctors may use the guidelines to better inform
patients with MCI about their increased risk for developing
Alzheimer’s disease. For clinicians with access to researchers
conducting biomarker and/or imaging studies, such
tests—while experimental—may be used to affirm suspicions
of Alzheimer’s disease.
Question: Can doctors use the guidelines to diagnose other
kinds of dementia besides Alzheimer’s disease?
Answer: The guidelines are specifically for Alzheimer’s
dementia.
Question: Should these new guidelines be used to
“re-diagnose”—that is, for those who already have a diagnosis
of Alzheimer’s disease?
Answer: As a physician, I do not see a role for the guidelines
being used to re-diagnose an individual who already has a
confirmed diagnosis. People who currently have the diagnosis
of Alzheimer’s disease are those with evident functional and
cognitive impairment. With lesser impairments, patients and
doctors might ask about mild cognitive impairment.
In any case, if you or a family member is worried about
changes in cognition, you may want to see a healthcare
professional such as a geriatrician, geriatric psychiatrist or a
neurologist. Early diagnosis aids in planning for the future,
from learning about available drugs that treat the symptoms,
to making financial decisions, to exploring ways to get
involved in clinical trials.
Question: Will these criteria impact current or future treatment?
Answer: It is the hope that these criteria will guide future
research and advance our discovery of the changes taking place
in the brain that lead to the development of Alzheimer’s disease.
With that discovery, we should be better positioned to develop
effective treatments.
Question: Are these the only guidelines doctors will be using now?
Answer: The NIA-Alzheimer’s Association guidelines have been
developed based on evidence by leading scientists in the
behavioral and clinical neuroscience fields. Thus, it is hoped
that clinicians will become aware of them and utilize them to
enhance how they think about patients with cognitive
impairment.
Question: Should primary care clinicians refer their patients to
a neurologist for a preclinical evaluation?
Answer: There currently is not a role for biomarkers in routine
care. The guidelines for preclinical Alzheimer’s disease are
exclusively for research purposes. Researchers will use new
advances in imaging and biomarkers to evaluate research
participants for buildup of abnormal proteins.
Primary care clinicians should consider referring patients who
wish to volunteer for research projects related to Alzheimer’s
disease. Research centers can be identified through the
Alzheimer’s Disease Education and Referral (ADEAR) Center
Web site maintained by NIA, at http://www.nia.nih.gov/Alzheimers/.
Question: Will insurance companies pay for biomarker tests?
Answer: Currently, it is common for Medicare to compensate
for a CT scan or MRI to help establish a clinical diagnosis of
Alzheimer’s disease and rule out other causes of dementia.
Testing for preclinical disease is only being conducted in
research settings. Looking ahead, a component of the new
Medicare Annual Wellness Visit (AWV) allows the clinician
compensation for an assessment for cognitive impairment on an
annual basis, along with multiple other preventive health
assessments. As better screening procedures are developed and
the guidelines become better [distributed] we expect clinicians
will increasingly recognize and monitor patients with MCI
during AWVs-- especially those patients who report memory
loss problems that often progress to Alzheimer’s disease.
Hopefully, this will be accompanied by counseling regarding
long-range planning, and education regarding available
community resources.
Posts
moving about more slowly than they used to, we often automatically assume that dementia is setting in. Since most forms of dementia are considered untreatable, we do the best we can to deal with the situation as it is without seeking medical help.
moving about more slowly than they used to, we often automatically assume that dementia is setting in. Since most forms of dementia are considered untreatable, we do the best we can to deal with the situation as it is without seeking medical help.
