Early Detection for dementia- Is it worth the cost?

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For the past 25 years, diagnosis of Alzheimer’s dementia has been based on clinical presentation. However, now experts from Alzheimer's Association and National Institutes on Aging have come up with newer guidelines to help make the diagnosis of this dreaded illness earlier.

William Thies, chief medical officer for the Alzheimer’s foundation, said, "These criteria will serve us in finding the kind of diagnostic tools and interventions that will help treat people in the earliest stages of the disease and avoid the severe symptoms that are so debilitating."

Since 1984, no new guidelines have been developed and the panel wanted to address the new advances in radiological imaging and use of biomarkers. At present, these experts do not currently recommend the use of biomarkers citing that many of the tests are not standardized and there is uncertainty how the markers relate to severity of the disease.

“We think that ultimately biomarker tests will help us be able to identify individuals with Alzheimer’s disease,” said Marilyn Albert, who chaired the panel’s workgroup on mild cognitive impairment. However, for now Albert said these markers are not ready to be used by physicians in clinical practice.

The experts hope to be able to assess individuals with “preclinical A.D.,” a term they coined to refer to individuals, chiefly those with a family history, who may have developed amyloidal matter in the brain but have not yet to develop symptoms of Alzheimer’s disease.

"Understanding the earlier stages may represent the best chance for treatment prior to symptoms becoming present," explained Dr. Reisa Sperling, of Brigham and Women's Hospital. “We want to be able to monitor a change from one's baseline over time."

While all this sounds magnificent, one should remember that these new diagnostic tools are simply more expensive scans, which are not yet approved by Medicare. With the current health budget crises, it is doubtful if Medicare will even pay for these scans. In many states, doctors have already been using these high-powered scans to determine presence of biomarkers to make diagnosis of Alzheimer’s dementia.

More importantly, there is a strong possibility that pharmaceutical companies could benefit from doctors who will start to prescribe more medications for early Alzheimer dementia, which in the first stages does not need any treatment.