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Alzheimer's, Dementia & Mental Health

New Guidelines for Alzheimer’s Diagnosis Starts with Pre-Alzheimer’s, Marks Advances

Some older people have abnormal levels of amyloid plaques, yet never show signs of dementia… amyloid deposits begin early in the disease process but tangle formation, loss of neurons occur later; new report for boomers, see below news story

Alzheimer's Association has also released a new book for baby boomers about AD, read more below news story.

April 19, 2011 - For the first time in 27 years, clinical diagnostic criteria for Alzheimer’s disease dementia have been revised, and research guidelines for earlier stages of the disease have been characterized to reflect a deeper understanding of the disorder. The guidelines released today cover the disease from pre-Alzheimer’s and across its many gradually changes over many years.

The new standards, known as the National Institute on Aging/Alzheimer’s Association Diagnostic Guidelines for Alzheimer’s Disease, outline some new approaches for clinicians and provide scientists with more advanced guidelines for moving forward with research on diagnosis and treatments.

“They mark a major change in how experts think about and study Alzheimer’s disease,” according to the joint news release. Development of the new guidelines was led by the National Institutes of Health and the Alzheimer’s Association.

 

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Read the latest news on Alzheimer's, Dementia & Mental Health

 

The original criteria were the first to address the disease and described only later stages, when symptoms of dementia are already evident. The updated guidelines announced today cover the full spectrum of the disease as it changes over years.

They describe the earliest preclinical stages of the disease, mild cognitive impairment, and dementia due to Alzheimer’s pathology. Importantly, the guidelines now address the use of imaging and biomarkers in blood and spinal fluid that may help determine whether changes in the brain and those in body fluids are due to Alzheimer’s disease.

Biomarkers are increasingly employed in the research setting to detect onset of the disease and to track progression, but cannot yet be used routinely in clinical diagnosis without further testing and validation.

“Alzheimer’s research has greatly evolved over the past quarter of a century. Bringing the diagnostic guidelines up to speed with those advances is both a necessary and rewarding effort that will benefit patients and accelerate the pace of research,” said National Institute on Aging Director Richard J. Hodes, M.D.

“We believe that the publication of these articles is a major milestone for the field,” said William Thies, Ph.D., chief medical and scientific officer at the Alzheimer’s Association.

“Our vision is that this process will result in improved diagnosis and treatment of Alzheimer’s, and will drive research that ultimately will enable us to detect and treat the disease earlier and more effectively. This would allow more people to live full, rich lives without—or with a minimum of—Alzheimer’s symptoms.”

The new guidelines appear online April 19, 2011 in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association.

They were developed by expert panels convened last year by the National Institute on Aging (NIA), part of the NIH, and the Alzheimer’s Association. Preliminary recommendations were announced at the Association’s International Conference on Alzheimer’s Disease in July 2010, followed by a comment period.

Guy M. McKhann, M.D., Johns Hopkins University School of Medicine, Baltimore, and David S. Knopman, M.D., Mayo Clinic, Rochester, Minn., co-chaired the panel that revised the 1984 clinical Alzheimer’s dementia criteria. Marilyn Albert, Ph.D., Johns Hopkins University School of Medicine, headed the panel refining the MCI criteria. Reisa A. Sperling, M.D., Brigham and Women’s Hospital, Harvard Medical School, Boston, led the panel tasked with defining the preclinical stage. The journal also includes a paper by Clifford Jack, M.D., Mayo Clinic, Rochester, Minn., as senior author, on the need for and concept behind the new guidelines.

The original 1984 clinical criteria for Alzheimer’s disease, reflecting the limited knowledge of the day, defined Alzheimer’s as having a single stage, dementia, and based diagnosis solely on clinical symptoms. It assumed that people free of dementia symptoms were disease-free. Diagnosis was confirmed only at autopsy, when the hallmarks of the disease, abnormal amounts of amyloid proteins forming plaques and tau proteins forming tangles, were found in the brain.

Since then, research has determined that Alzheimer’s may cause changes in the brain a decade or more before symptoms appear and that symptoms do not always directly relate to abnormal changes in the brain caused by Alzheimer’s. For example, some older people are found to have abnormal levels of amyloid plaques in the brain at autopsy yet never showed signs of dementia during life. It also appears that amyloid deposits begin early in the disease process but that tangle formation and loss of neurons occur later and may accelerate just before clinical symptoms appear.

To reflect what has been learned, the National Institute on Aging/Alzheimer’s Association Diagnostic Guidelines for Alzheimer’s Disease cover three distinct stages of Alzheimer’s disease:

   ● Preclinical –

The preclinical stage, for which the guidelines only apply in a research setting, describes a phase in which brain changes, including amyloid buildup and other early nerve cell changes, may already be in process. At this point, significant clinical symptoms are not yet evident. In some people, amyloid buildup can be detected with positron emission tomography (PET) scans and cerebrospinal fluid (CSF) analysis, but it is unknown what the risk for progression to Alzheimer’s dementia is for these individuals. However, use of these imaging and biomarker tests at this stage are recommended only for research. These biomarkers are still being developed and standardized and are not ready for use by clinicians in general practice.

   ● Mild Cognitive Impairment (MCI) –

The guidelines for the MCI stage are also largely for research, although they clarify existing guidelines for MCI for use in a clinical setting. The MCI stage is marked by symptoms of memory problems, enough to be noticed and measured, but not compromising a person’s independence. People with MCI may or may not progress to Alzheimer’s dementia.

Researchers will particularly focus on standardizing biomarkers for amyloid and for other possible signs of injury to the brain. Currently, biomarkers include elevated levels of tau or decreased levels of beta-amyloid in the CSF, reduced glucose uptake in the brain as determined by PET, and atrophy of certain areas of the brain as seen with structural magnetic resonance imaging (MRI). These tests will be used primarily by researchers, but may be applied in specialized clinical settings to supplement standard clinical tests to help determine possible causes of MCI symptoms.

   ● Alzheimer’s Dementia –

These criteria apply to the final stage of the disease, and are most relevant for doctors and patients. They outline ways clinicians should approach evaluating causes and progression of cognitive decline. The guidelines also expand the concept of Alzheimer’s dementia beyond memory loss as its most central characteristic.

A decline in other aspects of cognition, such as word-finding, vision/spatial issues, and impaired reasoning or judgment may be the first symptom to be noticed. At this stage, biomarker test results may be used in some cases to increase or decrease the level of certainty about a diagnosis of Alzheimer’s dementia and to distinguish Alzheimer’s dementia from other dementias, even as the validity of such tests is still under study for application and value in everyday clinical practice.

The panels purposefully left the guidelines flexible to allow for changes that could come from emerging technologies and advances in understanding of biomarkers and the disease process itself.

“The guidelines discuss biomarkers currently known, and mention others that may have future applications,” said Creighton H. Phelps, Ph.D., of the NIA Alzheimer’s Disease Centers Program. “With researchers worldwide striving to develop, validate and standardize the application of biomarkers at every stage of Alzheimer’s disease, we devised a framework flexible enough to incorporate new findings.”

About Information Sources:

The Alzheimer's Association is the world’s leading voluntary health organization in Alzheimer’s care, support and research. Their mission is to eliminate Alzheimer’s disease through the advancement of research; to provide and enhance care and support for all affected; and to reduce the risk of dementia through the promotion of brain health. For more information, visit www.alz.org. Media contact is Niles Frantz at 312-335-5777 or niles.frantz@alz.org.

The National Institute on Aging leads the federal government effort conducting and supporting research on aging and the health and well being of older people. The NIA provides information on age-related cognitive change and neurodegenerative disease specifically at its Alzheimer’s Disease Education and Referral (ADEAR) Center at www.nia.nih.gov/Alzheimers For more on health and on aging generally, go to www.nia.nih.gov. To sign up for e-mail alerts about new findings or publications, please visit either website.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

What other news sources are saying:

The emphasis on the need to diagnose Alzeheimer's during its earliest stages is also evident in Congress, where legislation introduced this month would create new, specific Medicare cost codes for early-disease diagnosis to address these steps, including the discussions between the physician and caregivers.

The New York Times: Guidelines Allow Earlier Definition Of Alzeheimer's
The drive to diagnose Alzheimer's before it has progressed into profound dementia is also reflected in a bill introduced in Congress this month, which would create specific Medicare cost codes for Alzheimer's diagnosis, including steps involving discussions between the patient's doctor and caregivers, a recognition that keeping family members well-informed can result in better planning and care (Belluck, 4/19).

The Associated Press: New Guidelines Define Pre-Alzheimer's Disease
The first new guidelines for diagnosing Alzheimer's disease in nearly 30 years establish earlier stages of the mind-robbing disease, paving the way for spotting and possibly treating these conditions much sooner than they are now. The change reflects a modern view that Alzheimer's is a spectrum of mental decline, with damage that can start many years before symptoms appear. The new guidance describes three phases: early brain changes, mild cognitive impairment and full-blown Alzheimer's (Marchione, 4/19).

Chicago Sun Times: New Guidelines For Identifying Alzheimer's Before Symptoms Occur
Medical experts have issued new guidelines for diagnosing Alzheimer's disease that, for the first time, attempt to identify the hallmarks of the disease before symptoms occur. The original guidelines, published in 1984, dealt only with diagnosing Alzheimer's once a person started showing signs of dementia. Since then, new discoveries have shown the disease can cause changes in the brain a decade or more before symptoms appear (Thomas, 4/19).


New Report, New Facts for Baby Boomers on AD from Alzheimer’s Association

Source: Alzheimer's Association generation alzheimer's: the defining disease of the    ● The new report, "Generation Alzheimer's: The Defining Disease of the Baby Boomers," sheds light on a crisis that is no longer emerging – but here.

   ● Many baby boomers will spend their retirement years either with Alzheimer's or caring for someone who has it.

   ● An estimated 10 million baby boomers will develop Alzheimer's.

   ● Starting this year, more than 10,000 baby boomers a day will turn 65. As these baby boomers age, one of out of eight of them will develop Alzheimer’s – a devastating, costly, heartbreaking disease. Increasingly for these baby boomers, it will no longer be their grandparents and parents who have Alzheimer’s – it will be them.

   ● "Alzheimer’s is a tragic epidemic that has no survivors. Not a single one," said Harry Johns, president and CEO of the Alzheimer’s Association. "It is as much a thief as a killer. Alzheimer’s will darken the long-awaited retirement years of the one out of eight baby boomers who will develop it. Those who will care for these loved ones will witness, day by day, the progressive and relentless realities of this fatal disease. But we can still change that if we act now."

   ● According to the new Alzheimer’s Association report, "Generation Alzheimer’s," it is expected that 10 million baby boomers will either die with or from Alzheimer’s, the only cause of death among the top 10 in America without a way to prevent, cure or even slow its progression. But, while Alzheimer’s kills, it does so only after taking everything away, slowly stripping an individual’s autonomy and independence. Even beyond the cruel impact Alzheimer’s has on the individuals with the disease, Generation Alzheimer’s also details the negative cascading effects the disease places on millions of caregivers. Caregivers and families go through the agony of losing a loved one twice: first to the ravaging effects of the disease and then, ultimately, to actual death.

   ● "Most people survive an average of four to six years after a diagnosis of Alzheimer’s disease, but many can live as long as 20 years with the disease. As the disease progresses, the person with dementia requires more and more assistance with everyday tasks like bathing, dressing, eating and household activities," said Beth Kallmyer, senior director of Constituent Relations for the Alzheimer’s Association. "This long duration often places increasingly intensive care demands on the nearly 15 million family members and friends who provide unpaid care, and it negatively affects their health, employment, income and financial security."

   ● In addition to the human toll, over the next 40 years Alzheimer’s will cost the nation $20 trillion, enough to pay off the national debt and still send a $20,000 check to every man, woman and child in America. And while every 69 seconds someone in America develops Alzheimer’s disease today, by 2050 someone will develop the disease every 33 seconds - unless the federal government commits to changing the Alzheimer’s trajectory.

   ● "Alzheimer’s – with its broad ranging impact on individuals, families, Medicare and Medicaid - has the power to bring the country to its financial knees," said Robert J. Egge, vice president of Public Policy of the Alzheimer’s Association. "But when the federal government has been focused, committed and willing to put the necessary resources to work to confront a disease that poses a real public health threat to the nation – there has been great success. In order to see the day where Alzheimer’s is no longer a death sentence, we need to see that type of commitment with Alzheimer’s."

The full text of the Alzheimer’s Association’s "Generation Alzheimer’s" report can be viewed at www.alz.org/boomers.

 

Financial Relief for Volkswagen Diesel Owners

You may be eligible for money damages if you owned or leased one of these VW, Porsche or Audi vehicles.

In the major scandal of 2015, Volkswagen cheated you and the world. They rigged diesel emission controls so you, nor regulators, would know how much pollution their cars were adding to our environment.

They were caught and have reserved $7.3 billion to help "make it right" with victims.

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Vehicles Involved

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VW Beetle (2012–2015)

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Audi A3 (2010-2015)

VW Touareg (2009–2016)

Porsche Cayenne (2015)

Audi A6, A7, A8, Q5 Quattro (2016)

 

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