Alzheimer’s diagnostic guidelines updated for first time in decades
New approaches for clinicians and more advanced guidelines for scientists provide direction for research on diagnosis and treatments of Alzheimer’s disease. Experts say effort will benefit patients and accelerate the pace of research.
Balintfy: For the first time in 27 years, clinical diagnostic criteria for Alzheimer's disease dementia have been revised, and research guidelines for earlier stages of the disease have been characterized to reflect a deeper understanding of the disorder.
Phelps: We've redefined Alzheimer's disease as a disease that occurs in three phases or three stages.
Balintfy: Dr. Creighton Phelps is the director of the Alzheimer's Disease Center Program at the National Institute on Aging. He says Alzheimer's disease is classically thought of in its final stage of dementia.
Phelps: However, there are stages before that, mild cognitive impairment and a pre-clinical stage that precede the development of the dementia that's associated with Alzheimer's disease.
Balintfy: The development of the new guidelines, led by the National Institutes of Health and the Alzheimer's Association, mark a major change in how experts think about and study Alzheimer's disease.
Phelps: Especially the pre-clinical phase, which is a research concept, not a clinical concept yet.
Balintfy: Dr. Phelps explains that the preclinical stage, which only applies to research, describes a phase in which brain changes may already be in process; but it is unknown what Alzheimer’s dementia risk is for these individuals.
Phelps: We're going to be able to eventually, hopefully after many more studies, be able to identify people early on who are on the road to Alzheimer's disease.
Balintfy: Research has already determined that Alzheimer's may cause changes in the brain a decade or more before symptoms appear. For example, some older people are found to have abnormal levels of amyloid plaques in the brain at autopsy yet never showed signs of dementia during life. Dr. Phelps adds that the guidelines discuss known biomarkers — signs that may be found in blood or spinal fluid – and mention others that may have future applications.
Phelps: Because if we find them early enough and we have interventions that will head off the disease, we can start the treatments early. There have been drug trials in the past that failed because we think may be the reason for the failure was it was too late. The brain was already damaged too badly and nothing they could do would correct that. However, if you catch the disease process before the brain has degenerated, then an intervention might work. Maybe some of the ones that failed earlier could even work if we do it earlier.
Balintfy: The other two distinct stages of Alzheimer's disease described in the new guidelines are Mild Cognitive Impairment and Alzheimer’s Dementia. For details on the National Institute on Aging/Alzheimer's Association Diagnostic Guidelines for Alzheimer's Disease and more information Alzheimer’s research, visit www.nia.nih.gov. This is Joe Balintfy, National Institutes of Health, Bethesda, Maryland.
About This Audio Report
Reporter: Joe Balintfy
Sound Bite: Dr. Creighton Phelps
Topic: Alzheimer's disease, dementia, guidelines, Mild Cognitive Impairment, Alzheimer's dementia, Alzheimer's research
Additional Info: Alzheimer's diagnostic guidelines updated for first time in decades