Alzheimer's disease diagnosed late

How much would you guess is spent annually in the U.S. on Alzheimer’s disease (AD)? $10 billion? $25 billion? $50 billion?

If you chose the third one, you’re half right. The answer is an astounding $100 billion, with more than 50% of those costs devoted to caregiving alone. But a new technology, combined with efforts to improve the diagnosis process, will hopefully bring significant and much needed changes to the way Alzheimer’s is treated.

Too little, too late

Far too often, Alzheimer’s disease is diagnosed too late to employ early measures that would slow down the degenerative process considerably. In fact, in approximately 80% of AD cases, general practitioners may be ignoring or simply not acting when their patients or their caregivers report early symptoms of AD.

That conclusion is just one that came out of the results of the Quality of Dementia Care Survey, conducted this past spring in five countries – Spain, France, Italy, the United Kingdom and Australia – by Alzheimer’s Disease International (ADI).

739 people who care for Alzheimer’s patients participated in the survey, and on the subject of early diagnosis their responses were disturbing. On average, as much as a full year or more may elapse between the first reported symptoms and the diagnosis.

Elizabeth Rimmer, the Executive Director of ADI, stresses how urgent it is for practitioners to recognize the symptoms of AD so that patients can quickly receive special care. She points out that, “Specialists then can diagnose and initiate treatment in the early stages of the disease, when slowing disease progression may have an impact and make a difference in patients’ and their caregivers’ lives.”

Going inside the brain

Prevention of Alzheimer’s disease was the topic of an e-Alert I sent you two weeks ago (“Stockholm in July” 7/24/02) when I told you about a number of newsworthy reports from the International Conference on Alzheimer’s Disease and Related Disorders. I promised to follow up on any additional reports of interest, and I found one that may have a dramatic impact on the early diagnosis of AD.

A team of researchers from the University of Pittsburgh used the occasion of the conference to present the first images from a high-resolution brain scan technique they developed to identify the onset of AD.

Long before the first signs of Alzheimer’s dementia, a protein called beta-amyloid begins to create plaque buildup in the brain. So the UP team developed a molecule that sticks to beta-amyloid. After a number of successful animal studies, a group of neurologists at the University of Sweden tested the technique by injecting the molecule into the brains of 14 human subjects; 9 had mild AD, while 5 were healthy and had no signs of dementia.

The results caused something of a sensation among researchers at the Stockholm conference. Images from positron emission tomography (PET) scans clearly showed how the molecule traveled effortlessly through the healthy brains. But in the brains of the subjects with Alzheimer’s, the molecule stuck in the frontal lobes and other regions that are typically damaged by plaque in AD patients.

Because it’s often difficult for doctors to be certain of the difference between dementia and full-fledged Alzheimer’s, this new technique may prove to be the first reliable way to diagnose the early stages of AD. When this screening might be widely available is hard to say, but I’ll watch for further developments and will keep you updated through the e-Alert.

Prevention and treatment

As we’ve seen, the early diagnosis of Alzheimer’s can have a profound positive impact on the quality of life for both AD patients and their caregivers. All too often, however, it’s the caregivers themselves who are responsible for delays in diagnosis, either from a lack of understanding, or a refusal to acknowledge the early symptoms.Last June I sent you an e-Alert (“Clear as a Bell” 6/26/02) with some basic but critical information for anyone who is concerned about a friend or family member who may be showing signs of dementia. You’ve probably heard that Alzheimer’s involves disorientation, forgetfulness and irrationality, but true Alzheimer’s symptoms take those qualities to sometimes alarming extremes, such as putting common items in a terribly wrong place or wearing clothing that’s entirely inappropriate for a given situation. Any observed behavior such as this should be followed up with immediate medical attention.In a recent e-Alert I told you about how important it is for everyone who lives in warm climates to understand the symptoms of a heat stroke. The same is true for Alzheimer’s. When more people learn to recognize the warning signals of AD and the importance of early diagnosis, the lives of AD patients and their caregivers will be significantly improved.

So please pass this e-Alert along to anyone you know who might need to see it. When we get the word out everyone will benefit.

To Your Good Health,

Jenny Thompson
Health Sciences Institute

Sources:
“National Health Care Access Restrictions Delay Alzheimer’s Disease Diagnosis, Treatment” Alzheimer’s Disease International, 7/8/02
“Scan Reveals Alzheimer’s Toxin” Academic Press, 7/24/02
“Study Shows Caregiver and Patient Costs Rise as Symptom Severity Increases in Alzheimer’s Disease” UCLA, 2/4//02