Research Slow To Refine Alzheimer's Diagnostic

For millions of aging Americans, no illness causes more anxiety than Alzheimer's disease. With even the tiniest hint of forgetfulness, alarm bells are set off and fearful patients insist that their memory is declining. This is particularly true for individuals with family histories of Alzheimer's disease.

Sadly, with respect to all the serious illnesses that afflict us, the advances in diagnosis and treatment of Alzheimer's disease have been especially disappointing. Despite a concerted research effort, our understanding of the true nature of the disease remains murky, accurate diagnosis during life is difficult, and treatment offers no more than a hollow promise that prescribed medications may provide one or two more years of independent life. Therapy may delay complete dependency and the need for placement in a nursing home. As the disease occurs predominantly in the oldest people, this protocol may lead to death from another cause before the final stages of the disease develop.

From fundamental-research scientists to clinicians caring for patients to pharmaceutical companies developing medications, there is a clear understanding that curing this illness is not yet in sight. However, hope is high that an eventual cure will be developed and available within our lifetime.

Because of these difficulties and the snail's pace at which progress is being made, all of the major pharmaceutical companies have committed to pool resources in order to identify new approaches to treatment more rapidly. This collaboration may lead to new insights and breakthroughs in research.

A large amount of research now is dedicated to arresting the disease long before permanent damage has occurred to the brain. Clinical trials are under way to try to stop the progression of the illness at multiple points. One medication may aim to eliminate deposits of abnormal proteins in the brains of Alzheimer's patients; another seeks to arrest the brain inflammation that accompanies the disease or to directly improve brain function and assist in returning memory to normal. To date, every promising trial has led to disappointing results.

Alzheimer's disease has a particularly slow progression, with abnormalities occurring in the brain 20 years before any symptom of memory loss appears. As a result, the diagnosis of Alzheimer's and the following drug treatments do not begin until the illness is well-entrenched. Many experts believe that effective treatment must begin much earlier, during the so-called preclinical stage, when pathology is present but symptoms are absent. This will require a great need for accurate diagnostic criteria.

The National Institute on Aging at the National Institutes of Health and the Alzheimer's Association recently convened a panel of experts to define the diagnostic criteria for the preclinical stage of Alzheimer's for those with early symptoms not sufficient to suggest Alzheimer's, as well as criteria to increase the likelihood of correct Alzheimer's diagnoses in symptomatic patients.

These recommendations are now available to the scientific community and the general public. Though screening tests are not yet available, many clinics already have received inquiries for these "preclinical" Alzheimer's screenings by individuals considered to be at high risk of developing Alzheimer's. And in the very near future, commercial groups likely will be offering these tests for a fee.

Currently, the diagnosis of preclinical Alzheimer's is only important to the research scientists, who urge that these tests are not yet appropriate for clinical diagnostic purposes. To identify preclinical Alzheimer's disease, researchers measure abnormal proteins that have been identified in the cerebrospinal fluid of patients with the disease. They also use highly sophisticated functional image technologies, such as a positron emission tomography scan, which can identify some of the earliest changes occurring in Alzheimer's.

Let's hope this research on the early inner workings of Alzheimer's disease ultimately will lead to a treatment that can cure the illness. Until then, those at increased risk can delay the possible development of symptoms by engaging fully in life, exercising the mind and the body as much as possible, and committing fully to a heart-healthy lifestyle that includes treating and preventing heart disease, high blood pressure and diabetes. Though the science has yet to offer much hope, patients always can take steps to promote health and prevent disease.

Dr. David Lipschitz is the author of the books "Breaking the Rules of Aging" and "Dr. David's First Health Book of More (Not Less)." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at www.DrDavidHealth.com.

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