Want to Know the Biggest Problem with Current Alzheimer's Disease Treatment?— It's Late Diagnosis

We all know about the obvious problems associated with Alzheimer's disease—but very few people know that late diagnosis is one of the biggest issues facing the public today. The media carries daily stories about the aging of the population structure (nearly 10,000 baby boomers turning 65 each day) and about how current medications seem to be minimally efficacious against this poorly understood disease. Our inability to treat a disease that affects a burgeoning elderly population also makes for dire headlines. However, there is a third problem associated with Alzheimer's disease that seems to be commonly overlooked in this conversation.

Alzheimer's Usually Diagnosed Too Late

This third problem is less obvious than the aging population structure and the lack of effective treatment, but solving it will greatly mitigate the impact of these more widely noted themes. The problem is the unacceptably late intervention that we practice against this progressive disease. We routinely diagnose Alzheimer's disease near end-stage pathology.

There is a fair degree of variability from case to case but, on average, Alzheimer's disease follows a 14-year course from the onset of subtle symptoms until death. This usually includes a 7-year period of mild cognitive impairment during which patients remain independent and able to care for themselves followed by a 7-year period of worsening dementia. In most instances, Alzheimer's disease is first diagnosed during the mild or moderate dementia stages. This correlates roughly to years 8 through 11 on the 14-year time line.

Late Diagnosis Affects Patients' Quality of Life

We are dealing with a progressive disease that ravages the brain with each passing year and, on average, we are not intervening with treatment until end-stage pathology and massive brain damage have occurred. Yes, we need better drugs but we can improve outcomes meaningfully by treating earlier with the currently approved agents.

Alas, earlier intervention is a sensible but slippery goal. This is because early-stage Alzheimer's disease patients, those in the mild cognitive impairment stage, have only mild symptoms. In this way, they appear to a physician precisely like the multitudes of "normally aging" patients who have accurately sensed a slowing of their word or name recall and are needlessly worried about Alzheimer's disease. As you might imagine, these two types of patients are difficult to distinguish from one another.

Since the chances are high that a 65-year old patient complaining of subtle memory decline does not have early-stage Alzheimer's disease, such concerns are usually not closely evaluated until symptoms worsen considerably. This has lead to the current practice of intervening only after the disease has progressed to the dementia stage when, by definition, the symptoms are quite pronounced.

Distinguishing "Normal" Memory Loss from Alzheimer's

Today, however, there are short neuropsychological assessments, such as the mild cognitive impairment screen, scored with sophisticated computer algorithms that accurately distinguish mild cognitive impairment from normal aging. These assessment tools perform an efficient traffic control function to escort the worried patients well out of the health care system while retaining those with objectively measured deficits for a comprehensive diagnostic workup. With such brief and inexpensive assessment tools, physicians can now intervene earlier and treat memory disorders like Alzheimer's disease before unnecessary brain damage has occurred. Doing so will foster a major improvement in standards of care for Alzheimer's patients.

In this regard, the major challenge to an immediate improvement in care becomes one of awareness and education for the masses and for primary care physicians. This is difficult but perhaps more certain in its achievability than the more scientifically challenging process of fully understanding Alzheimer's disease and developing treatment agents that will halt its progression.

We need to tackle this disease from all angles and getting an earlier start with intervention seems to be an immediately graspable approach that does not, in my opinion, get enough attention in the field.

Editor's Note: For further reading, see Alzheimer's Association Updates 10 Early Warning Signs of Alzheimer's Disease.

Posted in Brain Health, Memory Loss & Alzheimer's, Criteria for Diagnosing, Early Signs & Symptoms