Tags: Alzheimer's | Guidelines | Released

Alzheimer's Guidelines Released

Tuesday, 08 May 2001 12:00 AM

The expert panel, organized by the American Academy of Neurology released new guidelines for early detection, diagnosis and treatment of the disease, which they said should lead to changes in the way American physicians deal with Alzheimer's.

The guidelines are based on a review of more than 6,000 research studies, part of an "explosion of knowledge" that has changed the way scientists see Alzheimer's, according to neurologist James Stevens of the Fort Wayne Neurological Center in Fort Wayne, Ind.

Stevens was co-chair of an AAN committee established in 1998 to revamp the guidelines, which are intended to give doctors and their patients the most scientifically-solid information on the disease.

"These recommendations have meat behind them," he said. "There's evidence; they're not just someone's opinion."

Among other things, Stevens said, the new guidelines debunk the idea that it's impossible to diagnose Alzheimer's before the patient dies. He said physicians can use the guidelines to make diagnoses that will be accurate between 85 and 90 percent of the time.

"We don't think you have to die before we make a diagnosis," he said.

As well, he said, the guidelines say that the four Alzheimer's medications approved by the FDA will slow the progression of the disease and may delay the appearance of some of the symptoms, including memory loss and cognitive impairment.

(The four drugs -- Cognex, Aricept, Reminyl, and Exelon -- all prevent the breakdown of a chemical messenger that is low in the brains of Alzheimer's patients.)

"The key message is ...we can intervene and delay the time when [patients] have to be put in a nursing home," Stevens said.

The Alzheimer's Association, a national education and support group for people affected by the disease, welcomes the guidelines, according to spokesman Danny Chun.

"We are pleased that a comprehensive set of guidelines has been developed to help physicians treat Alzheimer's," he said, "and to help the public recognize the warning signs of Alzheimer's."

About 4 million Americans have Alzheimer's disease, and it's estimated that 14 million will have the illness by 2050, Stevens said. The direct and indirect costs amount to about $100 billion a year, he said.

"These guidelines really do tell physicians to do some things they weren't doing before and not to do some things they are doing," said UCLA neurologist Jeffrey Cummings, also a co-chair of the guidelines committee.

For instance, he said, physicians should take seriously small declines in memory or mental ability-known as Mild Cognitive Impairment -- which many previously dismissed as having no importance.

About 40 percent of people with MCI, he said, will progress to Alzheimer's within three years.

And he said the guidelines suggest that brain imaging studies should be a routine part of the initial examination of a possible Alzheimer's patient. "That's a new thing physicians weren't doing," he said.

On the other hand, he said, some doctors prescribe estrogen in post-menopausal women-a practice that should be stopped, because there's no evidence it works, he said.

The guidelines include 10 warning signs of Alzheimer's, first developed by the Alzheimer's Society. The signs are:

-- Memory loss that affects job skills

-- Difficulty performing familiar tasks

-- Problems with language

-- Disorientation about time and place

-- Poor or decreased judgment

-- Problems with abstract thinking

-- Misplacing things

-- Changes in mood and behavior

-- Changes in personality

-- Loss of initiative

Without widespread awareness of the warning signs, the Alzheimer's Association's Chun said, "people may delay seeking help.

Copyright 2001 by United Press International.

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The expert panel, organized by the American Academy of Neurology released new guidelines for early detection, diagnosis and treatment of the disease, which they said should lead to changes in the way American physicians deal with Alzheimer's. The guidelines are based on a...
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Tuesday, 08 May 2001 12:00 AM
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