Question: What is the difference between dementia and Alzheimer’s disease?
Answer: Dementia is the umbrella term for brain disorders that cause a person to lose their ability to function normally in daily life. Alzheimer’s disease is the most common, but there are other dementias, such as vascular, Lewy body, etc. Although we know Alzheimer’s dementia is distinct from these other forms, in the early stages it may be difficult to differentiate among them. Additionally, many older people may have more than one condition, such as Alzheimer’s disease combined with vascular disease and sometimes small strokes. That is one of the reasons why researchers hope one day to develop an easy-to-administer, reliable and inexpensive biomarker—a test that indicates harmful changes taking place in the brain—that can be used in a doctor’s office. For example, eventually there may be a simple blood test to help diagnose Alzheimer’s disease.
Question: How was dementia diagnosed before these new guidelines and what has changed?
Answer: The new guidelines do not dramatically alter the current process doctors use to diagnose Alzheimer’s disease. Dementia is still diagnosed based on significant and chronic changes in a person’s thinking processes, or as a professional would state, cognition. Healthcare providers speak with the patient and family or caregivers, seeking observations about changes in how the patient thinks, learns and remembers and taking into consideration other potential causes of cognitive decline—for example, medications, malnutrition, dehydration, depression. However, the new guidelines ask doctors to look beyond just memory loss for additional symptoms that may mark onset of the disorder, such as problems with judgment. And the revised guidelines outline ways the healthcare provider should approach evaluating the causes and progression of cognitive decline. For example, healthcare providers are made aware that mild cognitive impairment (MCI) may in many cases progress to Alzheimer’s disease and that memory impairment is not always the first symptom of Alzheimer’s.
Question: Where and how are biomarkers and new imaging tests being used?
Question: Why were the diagnostic criteria for Alzheimer’s disease revised and who led the effort?
Answer: The diagnostic criteria had been in place for more than 27 years and did not reflect the new knowledge that has been gained regarding the progression of the disease.
Some doctors may use the guidelines to better inform patients with MCI about their increased risk for developing Alzheimer’s disease. For clinicians with access to researchers conducting biomarker and/or imaging studies, such tests—while experimental—may be used to affirm suspicions of Alzheimer’s disease.
Question: Can doctors use the guidelines to diagnose other kinds of dementia besides Alzheimer’s disease?
Answer: The guidelines are specifically for Alzheimer’s dementia.
Question: Are these the only guidelines doctors will be using now?
Answer: The NIA-Alzheimer’s Association guidelines have been developed based on evidence by leading scientists in the behavioral and clinical neuroscience fields. Thus, it is hoped that clinicians will become aware of them and utilize them to enhance how they think about patients with cognitive impairment.
Question: Should primary care clinicians refer their patients to a neurologist for a preclinical evaluation?
Answer: There currently is not a role for biomarkers in routine care. The guidelines for preclinical Alzheimer’s disease are exclusively for research purposes. Researchers will use new advances in imaging and biomarkers to evaluate research participants for buildup of abnormal proteins.
Primary care clinicians should consider referring patients who wish to volunteer for research projects related to Alzheimer’s disease. Research centers can be identified through the Alzheimer’s Disease Education and Referral (ADEAR) Center Web site maintained by NIA, at http://www.nia.nih.gov/Alzheimers/.
Question: Will insurance companies pay for biomarker tests?