Monday, October 29, 2007
November is Alzheimer's Awareness Month
The Healing Project wishes to take this opportunity to cast a light across the entire spectrum of dementia. Alzheimer’s is a term often used as a catch-all for a group of symptoms characterized by a loss of memory judgment, language, motor skills, and impairment of other cognitive skills due to the damage or death of neurons. Alzheimer’s is large subset of dementia, but Alzheimer’s patients often present with more than one dementia. Complicating matters, many Alzheimer’s patients also exhibit depression, severe mental illness and other psychiatric conditions.
Diagnosis and Misdiagnosis
In the hands of a skilled clinical team, the diagnosis of Alzheimer’s can approach 85% in accuracy. Community-based screening techniques being pioneered by Rhonna Shatz, MD of the Henry Ford Health System offer the best model not only for correctly identifying patients’ disorders but also offering families the best continuity of care for those afflicted with dementia. It combines the latest technologies, medical instruments and clinical methods to render an accurate diagnosis and treatment.
It is essential that patients’ presenting with severe memory impairment are carefully and professionally screened for nutritional deficiencies (B1, B12, Folate), metabolic disorders (thyroid,etc.) depression, psychiatric illness, negative drug synergies (pharmaceutical dementia) before any formal diagnosis is made. All of the above conditions can be treated and the cognitive decline in many cases reversed. If none of the above conditions are present, a baseline genetic and medical history should be compiled to determine the probable type of dementia the patient might have. A panel should be assembled review the patient's case history that should include a cardiologist, neurologist, neuropsychologist, gerontologist and a psychiatrist. After the determination is made, the gerontologist or neurologist should design a course of care for the patient and the family should be counseled on caregiving practices and social services that may ease the transition as the ailment progresses.
Regrettably, the training of general practitioners has been lacking and many still use such flawed instruments such as Mini-Mental Status Exam (MMSE) to make a diagnosis. At the early stages of the dementia, the MMSE is a useless instrument and at late stages it is not very relevant as a child could identify the impairment. Newer, more powerful, cognitive screening instruments, such as the Headminder Cognitive Screening Tool (CST), are available but low reimbursement rates make its use limited only to the most advanced medical centers. Since no cure is available for Alzheimer's or any organic form of dementia and the available treatments are of limited value, little emphasis is placed on the screening and diagnosis of dementia in family practice.
Why Is Early Diagnosis Important?
Early diagnosis is important for two reasons:
1. Identifying patients early allows families to develop the resources and build the a support system necessary to comfort the afflicted; and
2. Identifying patients early offers the opportunity to participate in clinical research trials essential to the development of new courses of treatment for dementia.
For information about ongoing clinical trials visit Clintrials.gov. The Healing Project can not emphasize enough that every available patient should volunteer for these trials as it is the only hope of finding useful drugs.
The leading drugs available are the cholinesterase inhibitors such as Aricept and for later stage cases Namenda. Neither Aricept nor Namenda reverse the course of Alzheimer’s disease and have limited efficacy in treating the symptoms of Alzheimer's. Neither drug alters the progression of the disease.
More than 60 drugs are in clinic, but it is highly unlikely any compound will make it to approval. It is not that some of these compounds lack efficacy, it is manner in which they are screened and tested. The FDA and EMEA (Europe’s FDA equivalent), must re-examine how the drugs are tested to ensure those that do work are properly identified. The second issue is Alzheimer's research has been largely focused on a single theory for more than 20 years. The theory may simply be targeting a symptom as opposed to the cause or causes of Alzheimer’s. Precious time has been lost and a vast amount of resources misallocated. Clinical experience and post-mortem analysis argues that the etiology of the disease and its complex co-morbidities demand a radical rethinking of the conduct of Alzheimer’s research. The Alzheimer’s patient community must demand that both the NIH and Alzheimer’s research community begin to fund alternate theories of the disease process.
What can be done now?
If a loved one is exhibiting symptoms associated with dementia, it is incumbent on the family to seek the best diagnostic center available in their area. In the event the patient is diagnosed with dementia or Alzheimer’s, families should take full advantage of all the services available to help care for the afflicted. Proper nutrition, exercise and human interaction can have positive results in mitigating the speed of cognitive decline in most patients.
The Healing Project has published Voices of Alzheimer’s to offer perspective patients, caregivers, and families dealing with Alzheimer’s. It is available for purchase from Amazon.
Resources can be found at The Healing Project’s links section select Alzheimer’s.
For more information regarding Alzheimer’s Awareness Month’s activities:
National Alzheimer's Disease Awareness Month
225 North Michigan Avenue, 17th Floor
Chicago, IL 60601-7633