ALZHEIMER’S: A NEW SIMPLIFIED DIAGNOSIS METHOD
From the FMS Global News Desk of Jeanne Hambleton
Posted on July 7, 2014 by Stone Hearth News
How many patients receive an incorrect diagnosis of Alzheimer’s disease? The answer is a surprisingly high number: over a third!
To reduce the number of errors, the diagnostic criteria must be the most reliable possible, especially at the very early stages of the disease.
For the last decade, an international team of neurologists, coordinated by Bruno Dubois (Inserm/Pierre and Marie Curie University/AP-HP Joint Research Unit 975) has been working towards this.
In the June issue of The Lancet Neurology journal, we see how the researchers have developed a simplified diagnosis based on the most specific criteria of the disease. A challenge primarily for research, but also for clinical practice.
Alzheimer’s disease is a neurodegenerative disease. It is the most common (70%) form of dementia. In France, the number of people with Alzheimer’s disease and other forms of dementia is estimated at between 750,000 and one million, and is expected to reach 1.29-1.40 million patients by 2030. Alzheimer’s disease results from a loss of neurons.
The lesions are caused by an accumulation of some brain proteins. The pathology begins with memory problems. This is followed by problems of orientation in space and in time, behavioural problems and loss of autonomy.
However, these symptoms are not specific to Alzheimer’s disease. The real challenge is to know how to distinguish this disease from other types of dementia, and establish the diagnosis as reliably and as early as possible.
In 2005, an international group of neurologists, coordinated by Bruno Dubois at Inserm, came together to redefine the diagnostic criteria established in 1984.
Until then, it had been necessary to await the death of a patient in order to establish a diagnosis of Alzheimer’s disease with certainty by examining the lesions in his/her brain. And in the living, only a probability of disease could be inferred, and only at a late stage, based on a certain threshold of severity of dementia.
In 2007, the international team shattered these concepts. The researchers introduced new diagnostic criteria, particularly biomarkers. These are genuine signatures of the disease, and are present from the initial symptoms (prodromal stage).
The publication of these results constituted a revolution. Researchers then observed that with these new criteria, “36% of their patients included in a therapeutic trial based on previous clinical criteria did not have Alzheimer’s disease,” reports Bruno Dubois.
And although this analysis involved only a subgroup of patients, the implications are serious. Patients did not receive the correct treatment and/or care. And flawed patient selection might have had an impact on the lack of efficacy observed for the new treatment.
Since 2007, many studies have been published. And the international group decided to analyse this literature to make the diagnostic algorithm for Alzheimer’s disease simpler and more reliable.
“We have reached the end of the road; we have arrived at the essence, something refined, resulting from an international consensus”, indicates Prof. Dubois.
The diagnosis of Alzheimer’s disease will henceforth rely on “just a couple of clinical-biological criteria for all stages of the disease”.
Most of the time, the diagnosis of Alzheimer’s disease is based primarily on a suggestive clinical picture. It is subsequently confirmed or rejected using a biomarker.
As regards the clinical picture, there are three scenarios:
– Typical cases (80-85% of all cases): impairment of episodic long-term memory (known as amnestic syndrome of the hippocampal type and corresponding to difficulty remembering a list a words, even with clues, for example)
– A typical cases (15-20% of cases): atrophy of the posterior part of the cerebral cortex or logopenic aphasia (impairment of verbal memory where the patient inverts the syllables of a word when repeating it, for example), or frontal brain damage (which results in behavioural problems)
– Preclinical states: asymptomatic at-risk (patients without symptoms, but who are fortuitously discovered to have positive biomarkers during scientific studies), and presymptomatic (with a genetic mutation)
– One of the following two biomarkers is required:
– In the cerebrospinal fluid (obtained by lumbar puncture): abnormal levels of brain proteins (reduced beta amyloid protein and increased tau protein)
– In the brain by PET (positron emission tomography) neuroimaging: elevated retention of amyloid tracer.
This simpler and more reliable algorithm is important, primarily for research (therapeutic trials, characterisation of the disease, monitoring of patient cohorts, etc.). Outside of research, the use of biomarkers, which is expensive and/or invasive, currently remains limited to young patients or difficult or complex cases in expert centres.
Sources The Lancet Neurology, vol.13, juin 2014
LEARNING TO SPEAK ALZHEIMER’S: A GROUNDBREAKING APPROACH FOR EVERYONE DEALING WITH THE DISEASE
The article is linked with a book written by Joanne Koenig Coste.
This appears to be a book written by someone who cares and possibly had personal experience. I believe almost every aspect of the patient’s life is written about and would certainly help a family with a relative with Alzheimer’s disease.
The new book published this month on Amazon.co.uk is shown as only one new book in stock is £37.20. This is with the “Groundbreaking Approach”. There is also an alternative audio CD for £17.64.
An earlier edition published in 2003 with a “New Approach….” is on sale for £12.80 or £8.93 paperback with an alternative audio CD for £17.64.
If you are sadly involved it is worth a read.
FROM EINSTEIN TO OPRAH: FAMOUS FACES MAY HELP SPOT EARLY DEMENTIA
From the News Desk of Jeanne Hambleton
Source Newsroom: American Academy of Neurology (AAN)
Newswise — MINNEAPOLIS – A recent study suggests that simple tests that measure the ability to recognize and name famous people such as Albert Einstein, Bill Gates or Oprah Winfrey may help doctors identify early dementia in those 40 to 65 years of age. The research appeared in print issue of Neurology®, the medical journal of the American Academy of Neurology.
“These tests also differentiate between recognizing a face and actually naming it, which can help identify the specific type of cognitive impairment a person has,” said study author Tamar Gefen, MS, of Northwestern University Feinberg School of Medicine in Chicago. Gefen worked alongside Emily Rogalski, PhD, also with Northwestern University, for the research.
For the study, 30 people with primary progressive aphasia, a type of early onset dementia that mainly affects language, and 27 people without dementia, all with an average age of 62 were given a test. The test includes 20 famous faces printed in black and white, including John F. Kennedy, Lucille Ball, Princess Diana, Martin Luther King Jr. and Elvis Presley.
Participants were given points for each face they could name. If the subject could not name the face, he or she was asked to identify the famous person through description. Participants gained more points by providing at least two relevant details about the person. The two groups also underwent MRI brain scans.
Researchers found that the people who had early onset dementia performed significantly worse on the test, scoring an average of 79 percent in recognition of famous faces and 46 percent in naming the faces, compared to 97 percent in recognition and 93 percent on naming for those free of dementia.
The study also found that people who had trouble putting names to the faces were more likely to have a loss of brain tissue in the left temporal lobe of the brain, while those with trouble recognizing the faces had tissue loss on both sides of the temporal lobe.
“In addition to its practical value in helping us identify people with early dementia, this test also may help us understand how the brain works to remember and retrieve its knowledge of words and objects,” Gefen said.
The study was supported by the National Institute on Deafness and Other Communication Disorders, the National Institute on Aging, the National Center for Research Resources, the National Institute of Neurological Disorders and Stroke and the National Center for Research Resources.
The American Academy of Neurology, an association of more than 26,000 neurologists and neuroscience professionals, is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer’s disease, stroke, migraine, multiple sclerosis, brain injury, Parkinson’s disease and epilepsy.