In search of Alzheimer’s
.
Alzheimer's Donation
Donate Online Now
.

Does the diagnosis of dementia come years too late? There’s plenty of evidence that the processes leading to Alzheimer’s disease (AD) and other dementing illnesses begin as early as age 30 or 40. Dementia, according to the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV), is a syndrome that may be caused or characterised by multiple cognitive deficits, which include memory impairment and at least one of the following: aphasia, apraxia, agnosia or disturbance in executive functioning. Social or occupational function is also impaired. Moderate dementia, according to the standard Clinical Dementia Rating Scale, implies difficulty in performing acts like dressing, bathing, and toileting. Yet it is estimated that more than two-thirds of people with Alzheimer’s disease are already moderately demented by the time they receive a diagnosis, and more than half of those now suffering from dementia have never been diagnosed by a physician.Some may wonder whether early diagnosis matters, since as yet there is no way to cure or prevent the most common type of dementia. However, research is producing both more potential ways to recognise the symptoms at an early stage and more reasons for needing to.Early diagnosis of AD allows time to initiate appropriate treatments that may delay cognitive deterioration and to consider such nonpharmacologic interventions as behaviour therapy. Additionally, early diagnosis provides the patient and family with time to plan for caregiving and management decisions, proper referrals and legal and financial decisions. More importantly for research purposes, earlier detection of the signs of dementia would make clinical trials easier to conduct, and the development of drugs and other treatments would become quicker, safer, and more effective. Here, the two lines of research converge and reinforce each other. The earlier we can detect Alzheimer’s disease, the better chance we have of finding ways to treat or prevent it; and the more we learn about risk factors and potential treatments, the more important early detection will become.However, given the lack of an effective treatment, early detection could have some drawbacks. Surveys show that most people don’t want to take a test for future Alzheimer’s disease unless it is more than 90% accurate — a level that is still unreachable. A study found that children of Alzheimer’s patients did not become depressed or anxious when they were told that they carried the APO E4 genetic variant. But they were six times more likely to buy long-term care insurance, which is both good and bad news. Certainly in the US, federal law restricts the use of genetic information to deny health insurance, but the law does not apply to long-term care insurance. If the number of people carrying this insurance who develop Alzheimer’s increases, the cost will rise for everyone.That problem requires a political solution, but otherwise knowing the risk has obvious advantages. Patients can decide whether to participate in clinical research. People who learn they are not going to develop Alzheimer’s will be able to rest easier. Early diagnosis would also allow patients with other, reversible causes of dementia to receive proper treatment.