New Guidelines re Alzheimer's Disease

The National Institute on Aging and the Alzheimer's Association just published a revision to their original 1984 guidelines regarding the diagnosis of Alzheimer's disease.  One would think that after 27 years of research and advancement, there might be some dramatic changes & updates.  Surprisingly for those of us in the trenches in routine practice, there's really nothing new!

While diagnostic accuracy, beyond clinical examination & patient/caregiver reports, can be improved upon with genetic testing, PET scans using amyloid binding ligands, and cerebrospinal fluid assays for beta-amyloid, it's still recommended that such testing be reserved for research only.

So why test for these changes?  From a research perspective, we need to know if someone we've enrolled in a preventive study is actually at risk by dint of the above tests.  In fact, a whole paper was published looking at how to define such a preclinical stage of AD, even before the onset of mild cognitive impairment due to AD.  This is continuum of disease is consistent with the ability to predict AD via brain atrophy 10 years prior to clinical manifestation as pointed out 2 days ago.

But for most patients already presenting w/memory loss affecting cognitive function w/demonstrable loss from a previously higher level of function, in the absence of any findings consistent with vascular dementia, dementia w/Lewy bodies, and/or frontotemporal dementia, we can comfortably make a diagnosis of AD after a standard work up, including neuroimaging.

If your patients like the NY Times or WSJ, those papers have a nice write up.  So, too, does USA Today.  Or they can watch CBS Early Show and most any other TV news channel.  But whatever you & your patients read/watch, check out Generation Alzheimer's as the oldest of the Baby Boomers turns 65yo this year, of whom 1 in 8 will develop AD.  While we can't absolutely prevent AD, we can certainly lower our risk.  Personally, I'd rather spend my time urging my patients to live a healthy lifestyle in order to improve their odds against AD, and in doing so, also against heart disease, stroke, and cancer.