April 20--New guidelines for diagnosing Alzheimer's disease will include people with early signs of the condition and eventually could allow doctors to identify those who are likely to develop the mind-robbing disease, experts said Tuesday.
The guidelines, issued by the Alzheimer's Association and the National Institute of Aging, redefine the illness as a long process that starts with plaque buildup in the brain before symptoms occur. They acknowledge researchers' use of biomarkers -- such as levels of certain proteins in blood or spinal fluid -- that indicate the illness, but experts cautioned doctors can't yet rely on such indicators for diagnoses.
"We have to be very careful how we use these (guidelines), because you may find out that the person has the disease using the biomarkers, but we don't have a cure to offer this person," said Dr. Oscar Lopez, director of the Alzheimer's Disease Research Center at the University of Pittsburgh. "If a person has a biomarker, we don't know when that person will develop the disease."
The guidelines recognize three phases of Alzheimer's, starting with a preclinical stage in which tests detect build-up of an abnormal protein in the brain even when the patient doesn't display symptoms.
The second phase, called mild cognitive impairment, consists of less severe memory lapses that in some cases develop into dementia as a person ages. Those people often are unable to learn information or have trouble expressing themselves or thinking of a word.
The agencies' guidelines end with full-blown Alzheimer's, in which patients have trouble recalling words and show impaired reasoning and judgment that make it difficult for them to function complete day-to-day activities.
"Sooner is better than later when it comes to diagnosis and detection," said Bob LeRoy, president and CEO of the Greater Pennsylvania Chapter of the Alzheimer's Association. "Our hope is that more people will be diagnosed earlier."
Carol Schramke, who evaluates patients in the neurology department at Allegheny General Hospital, said having better tools to define the illness should ease worries among people showing typical signs of aging. It could help people make plans and arrange for support before their illness progresses, she said.
"This should help people appreciate that mild changes might be normal, but maybe you need to be paying more attention to those mild changes and seek treatment," said Schramke, director of behavioral neurology.
There are no approved drugs to prevent or stop the development of Alzheimer's, but some drugs are believed to slow its progression. The Alzheimer's Association says available drugs mask symptoms of the illness but don't necessarily treat the underlying disease. Earlier identification of symptoms could lead doctors to prescribe those medications sooner, Schramke said.
"We certainly hope that the sooner you give these medicines to people, the more likely it is you are going to have more abilities to preserve," she said.
The guidelines, updated for the first time in 30 years, are likely to increase the number of people diagnosed every year with the illness, the association said. An estimated 5.4 million Americans have the disease, including as many as 400,000 in Pennsylvania, LeRoy said. About 16 million are projected to develop Alzheimer's by 2050, he said.
The guidelines accentuate the need for money to study the illness, LeRoy said, noting more than 100 drugs are under development to treat the illness. More money could speed clinical trials for the drugs, he said.
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