Scientists Update Alzheimer's Disease Guidelines

A group of scientists has proposed new guidelines for diagnosing Alzheimer's disease. Their goal is to get doctors to recognize Alzheimer's earlier. Michele Norris speaks with NPR's Jon Hamilton.

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MICHELE NORRIS, host:

A coalition of doctors and researchers is proposing new guidelines for diagnosing Alzheimer's disease. And they have support from the National Institute on Aging and the Alzheimer's Association. The guidelines call for doctors to recognize people who are likely to develop Alzheimer's, as well as those who already have the mental impairments associated with the disease.

NPR's science correspondent Jon Hamilton is here in the studio to talk about all this. Jon, why are they making this change?

JON HAMILTON: The biggest reason is that right now most doctors are using diagnostic criteria that came out in 1984. Most researchers thought that if you didn't have a problem with memory or thinking, your brain was probably OK. But since then, it's become pretty clear that the brain can start to change a decade or more before it gets hard to remember things.

NORRIS: So, what is it that starts to change? What can they detect?

HAMILTON: Well, you can start to see things like the brain shrinking, plaques developing in the brain. You can start to see things change in the spinal fluid. Those are all things that they say really are just for scientific studies right now, for experiments. But you can also see things like much milder of conditions in Alzheimer's. You have what's called mild cognitive impairment.

And that's where it's not interfering with your life, you don't forget where you live or something, but if you do tests, you can see subtle changes that mean you just don't remember things or you don't think quite as clearly as you used to.

NORRIS: So if they can spot these things early on, what difference would that make?

HAMILTON: Well, in a lot of ways, it really won't make any difference, at least not for patients. It's not going to change how you treat Alzheimer's. It's not going to change what doctors do. But what it is going to change is if doctors actually start following these guidelines and diagnosing people earlier with milder symptoms, it's going to really increase the number of people who fall into this sort of larger Alzheimer's category.

You know, right now the statistics show that there are more than five million people in the U.S. with Alzheimer's. But the scientists think that there are at least that many more people who have these less serious forms. So you could look like there was just this explosion in the Alzheimer's numbers.

NORRIS: Will this help people who have Alzheimer's?

HAMILTON: There's a lot of debate about that. You know, the problem is that right now there really aren't any drugs that work to treat Alzheimer's. Knowing that you have it doesn't mean that you're going to get an intervention that's going to make any difference.

Now, you've got groups like the Alzheimer's Association that say, well, it can be helpful to know that, you know, you're in the earliest stages of this disease. Maybe you decide to draw up a will or arrange for long-term care. On the other hand, you have people who say, well, you know, learning that you have this thing that might be a terminal disease, you might not want to carry that information around with you.

NORRIS: Jon, are there other reasons to diagnose people earlier?

HAMILTON: Well, there might be if you were, you know, trying to plan care for a loved one that you think might be in the early stages. It might help your planning there. On the other hand, one of the problems here is that let's say that you get diagnosed with mild cognitive impairment, it doesn't necessarily go on to lead to Alzheimer's. So you're not really given a very firm diagnosis.

There are also reasons, you know, if you were one of the groups that advocates for people with Alzheimer's disease, if there is more awareness of it because many more people are falling in the diagnostic category, you know, it's going to be good for you, it'll be easier to get money for it.

And, also, if you're a scientist doing research on people with Alzheimer's disease, everybody agrees that if any of these treatments are going to work, they're probably going to work best on people in the very earliest stages. And so you can't try that out unless you've identified a bunch of those people and gotten them into scientific studies.

NORRIS: That's NPR's Jon Hamilton. Jon, thanks so much.

HAMILTON: You're welcome.

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