Several new promising treatments for Alzheimer’s Disease (AD) have very recently become available. But they will only make a significant impact if we can diagnose Alzheimer’s at much earlier stages, even when the changes in the brain are not obvious clinically.
Fortunately, there have been several very exciting new ways to diagnose AD before there are any signs. Until very recently, the diagnosis was made as a “rule-out” after the other causes of dementia were ruled out with head imaging, blood tests, and spinal taps (infection in the brain, autoimmune disease, ministrokes, etc…). We weren’t doing much better than chance in making the diagnosis, with a recent paper stating we only arrived at the right diagnosis 60% of the time. But, the discoveries of what causes AD-deposition of the proteins amyloid and tau- have lead not only to treatments but to diagnostic tools as well.
Now we don’t “rule out” the other possible causes, but rather we “rule in” the correct diagnosis of AD. We have biomarkers in the blood, changes in PET scans looking for an excess deposit of specific proteins (amyloid and tau), and spinal fluid tests. We can catch the diagnosis early enough, in pre-AD phases such as pre-clinical (someone concerned because a family member has AD), mild cognitive impairment (MCI) or mild dementia.
While the PET scans and spinal fluid tests are very sensitive in looking for amyloid and tau, the newer bloodtests are less expensive, more invasive, and require a specialist to order them. As over 75% of neurologic patients are diagnosed by and cared for by their primary care physician (PCP) and as primary care doctors diagnose 64% of older adults with dementia in the US, it is imperative that we give primary care doctors the best tools. Now a PCP can order a simple blood biomarker that accurately identify AD 90% of the time. There are several currently available and many more coming down the pike.
Clinical suspicion is still the initial step in the diagnosis of AD. The PCP will still be the one making the diagnosis the majority of the time. With these new tests and with the growing shortage of neurologists, these blood tests will be an invaluable tool that will lead to earlier detection, earlier treatment and better patient outcomes.
The BeCare Neuro App can assist both patients and physicians in remotely detecting cause to suspect the diagnosis of dementia early. We offer gamified apps that assess cognitive health and compare an individual’s performance against the general population. The results can be obtained in a report form that can be shared with your PCP.
Citation: New Diagnostic Criteria for Alzheimer's Will Change Practice – Medscape – September 10, 2024.
https://www.medscape.com/viewarticle/new-diagnostic-criteria-alzheimers-will-change-practice2024a1000g76ecd=wnl_tp10_daily_240914_MSCPEDIT_etid6823270&uac=152547CG&impID=6823270