DEAR DR. GOTT: My 73-year-old father seems rather forgetful these days. When I took him to his doctor, he was diagnosed with pre-Alzheimer’s disease. I’ve heard of Alzheimer’s, but what exactly is pre-Alzheimer’s?
DEAR READER: It is estimated that more than 5 million Americans suffer from a form of Alzheimer’s, the leading cause of dementia in the Western world. There are new guidelines available for diagnosing early-stage Alzheimer’s (pre-Alzheimer’s), indicating that a state of mental decline can begin years prior to the occurrence of other, more classic symptoms.
According to the new strategy, there are three phases, identified as early brain changes, mild cognitive impairment and full-blown Alzheimer’s. Oddly enough, while the phases have been identified clearly, doctors are advised to evaluate and treat patients with symptoms in the same manner as they did previously.
Laboratory or brain images will provide useful information for proper diagnosis. Your father may have a thyroid disorder, vitamin B12 deficiency or some other unrelated condition that is easily treatable. One problem with current biomarker testing through blood and spinal fluid is that there is no standardization between labs, nor are there set levels for how much of a substance indicates impairment or Alzheimer’s. This implies that if I am in one section of the country, I could test positive, while testing negative in another locale. And there is insufficient research to validate that a particular substance or biomarker can predict progression of the disease. It is important to note that the only way to confirm a diagnosis of Alzheimer’s is at autopsy.
Current treatment can ease symptoms, but it doesn’t alter the course or progression of the disease. However, on the flip side of the coin, if you know your father is exhibiting early signs, you can take appropriate steps for him and those around him to learn to cope with potential future changes. Medication, treatment plans and support are available.
