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Experts: Find and Fight Alzheimer's Early

New guidelines seek to end 'nihilistic' approach

MONDAY, May 7 (HealthScout) -- Alzheimer's disease is becoming a treatable condition, and family members and doctors should be aware of its early signs so that its progression can be slowed, say new practice guidelines announced today.

"The main message is that there are things that can be done to improve the outcome for these patients, instead of the nihilistic approach of the past," says Dr. James Stevens, associate professor of neurology at the Indiana University School of Medicine. "We encourage families and physicians to detect the condition early so that interventions can be started."

Stevens is co-author of the guidelines, which were announced in Philadelphia at the annual meeting of the American Academy of Neurology.

The Food and Drug Administration (FDA) has approved three anticholinesterase drugs for treatment of Alzheimer's. The drugs block the activity of an enzyme that breaks down acetylcholine, a chemical involved in brain function. Others are on the way, says Bill Thies, vice president of medical and scientific affairs at the Alzheimer's Association, which played an active role in development of the new guidelines. They are also being published in the May 8 issue of the journal Neurology.

"If you look at the FDA Web page, you can see that there are about 25 trials going on with drugs related to Alzheimer's disease," Thies says. "There has been a significant increase in the last few years, and there likely will be a number of new medications approved in the next few years."

One class of promising drugs are the nonsteroidal anti-inflammatory medications now used for arthritis and other joint disorders, Stevens says. If current studies go well, they could be approved for treatment of Alzheimer's and other dementias in the next year or two, he says. Human trials of a vaccine that has prevented formation of the amyloid plaques involved in mental function in animals have begun, with results expected in five to seven years. "The vaccine is potentially a cure," Stevens says.

Treatment or prevention of Alzheimer's disease is an urgent issue in a rapidly aging American population, Thies says. It affects 10 percent of those over 65, and nearly half of those over 85.

The Alzheimer's Association has a list of 10 symptoms indicating a need to consult a doctor. Memory loss that affects daily function is at the top of the list. "It's not so much forgetting where you put the car keys," Thies says. "I do that two or three times a week. It's when you can't remember what the car keys are for."

Other warning signs include:

  • Difficulty performing familiar tasks;
  • Problems with language;
  • Disorientation that leads to getting lost;
  • Problems with abstract thinking;
  • And changes in mood or behavior.

The guidelines, based on more than 1,000 studies, describe tests for diagnosing Alzheimer's disease and options for treatment and care. Those guidelines are aimed at general practitioners as well as neurologists, Thies says.

"Neurology is one of the smallest specialties, so most of the time it is a nonspecialist who identifies a patient who has Alzheimer's disease or another mental problem," he says. "You might want to refer the patient to a specialist, but the first line of defense is your own doctor."

What To Do

Many people are under the belief that Alzheimer's is a disease that can be diagnosed only after death. These guidelines aim to stop that notion.

"Patients with memory impairment in old age need to be followed closely, because they often progress to Alzheimer's," Stevens says. "On examination, if everything looks well except memory loss, when you follow that patient population, a significant percentage progress to Alzheimer's."

To learn more about the condition, look at the American Academy of Neurology or the Alzheimer's Association.

You could also try other HealthScout articles about Alzheimer's disease.

SOURCES: Interviews with Bill Thies, Ph.D, vice president of medical and scientific affairs, Alzheimer's Association, Chicago, and James Stevens, M.D., associate professor of neurology, Indiana University School of Medicine, Indianapolis; May 8, 2001 Neurology
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