The Early Diagnosis Problem with Alzheimer’s

Douglas Watt from Harvard Medical School provided a useful update on Alzheimer’s research at the National Academy of Neuropsychology conference earlier this month. His key points:

1. Late diagnosis of memory loss and cognitive impairment contribute to underestimation of the problem – the current estimate of 5.5 million with Alzheimer’s in the US alone is probably low.

2. Many physicians and associated health care providers still rely on the Mini-Mental State (MMSE) paper exam, which isn’t very useful for early stage memory impairments – MMSE is good for measuring moderate to severe dementia, but that doesn’t help with the goal of catching early signs of cognitive impairment. This is a prime reason why computer based cognitive screening can be very effective in a primary care setting.

3. A combination of short term memory screening and biomarker tests is the best scenario for catching Alzheimer’s in the pre-clinical, or prodromal phase. Biomarker tests for Alzheimer’s are all over the map right now (including very high false positive results with some tests), so this will take a while to sort out.

4. Moderate daily exercise, foods with high antioxidant content, and positive social engagement reduce the chances of developing Alzheimer’s. Sedentary daily routines, obesity, Type II diabetes, and social isolation greatly increase chances for Alzheimer’s and other forms of dementia.

There was also an interesting discussion on the role of general inflammation in the brain as a cause of Alzheimer’s. There is increasing speculation that beta amyloid may not be the cause of Alzheimer’s, but more of a symptom. This has implications for future drug discovery efforts, with more of a focus on compounds that reduce CNS inflammation.